Atypical cells of uncertain significance (ASCUS), or low grade squamous intraepithelial lesion (LSIL) smears, remain a challenge in cervical screening algoritms. These smear results may indicate the presence of high grade disease, but in the majority this is not the case, and many of the low grade lesions will clear by itself. In case of an ASCUS/LSIL smear and a normal colposcopy it remains uncertain whether further follow up is needed and if age plays a role in management.
This presentation will focus post colposcopy management of women with an ASCUS/LSIL smear withc specific reference to age, and other markers.
The literature was searched regarding the follow-up of women with ASCUS/LSIL and normal colposcopy with specific regard to the effect of age on the incidence of CIN 2/3. Although studies have reported on the follow-up after ASCUS/LSIL and normal colposcopy, the relation with age has not been investigated specifically. As many other factors may play a more important role than age in the follow-up after ASCUS/LSIL, the literature was searched focussing on ASCUS/LSIL with normal colposcopy, and the use of additional markers during post colposcopy management.
The largest cohort study reporting on follow up of women with ASCUS/LSIL and normal colposcopy is the ALTS trial. This trial showed that, after ASCUS/LSIL and colposcopy with/without biopsy indicating < CIN2 in 1836 women, a 10% risk of CIN 2+, and a 7% risk of CIN 3+, within 2 years of follow up remained. Age did not significantly influence these percentages but persistent hr-HPV detection was the strongest predictor, followed by follow up smear result en follow up colposcopic impression. Within the persistent hr-HPV positive women, a further risk stratification was possible with the highest risk in HPV 16 positive women followed by HPV 18 and 45. However, even among women who are HPV negative a 2-4% risk of CIN 3+ within 1-2 years follow-up was present.
In women with ASCUS/LSIL cytology and a subsequent colposcopy, excluding CIN 2+, there is an increased risk on CIN2+ during 2 years of follow up. hr-HPV persistence is the strongest predictor, especially HPV 16. Follow-up cytology and colposcopy are less strong predictors, while a small number of hr-HPV negative women are found with CIN 2+ during follow-up. These results indicate that women with ASCUS/LSIL and colposcopy still need follow-up preferably with hr-HPV genotyping and cytology co-testing.
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