Atypical squamous cells of undetermined significance: Do we need colposcopy?

The authors reviewed the records of women with Papanicolaou (pap) smears interpreted as atypical squamous cells of undetermined significance (ASCUS) to determine the incidence of underlying dysplasia and to formulate a cost-effective triage protocol. One hundred twenty-nine county health department patients referred for colposcopy after an ASCUS smear between January 1991 and June 1996 constituted the study population. Demographic data, gross colposcopic impression, and repeat cytology and cervical biopsy results were reviewed. At the time of colposcopy, 78/122 women had normal repeat cytology. Biopsies were performed on 81 patients; 32/81 biopsy results were normal, 36/81 revealed low-grade lesions, and 13/81 revealed high-grade lesions. The expense of three triage methods was analyzed and found to cost $294/patient for the repeat cytology protocol, $335/patient for immediate colposcopy, and $375/patient for the human papillomavirus testing protocol. There was a significant rate of underlying high-grade dysplasia (10.1%) in the patient population studied. Patients with normal repeat cytologic results had a significant rate of underlying low-grade dysplasia (25.6%) and a small risk of high-grade dysplasia (2.6%). Repeat pap smear may be effectively used to screen for high-grade lesions in this patient population. On the basis of these data, cost analysis, and the high rate of noncompliance in the population studied, the best method for managing health department-referred patients with ASCUS cytology appears to be immediate colposcopy.