Which cytology results predict cervical intraepithelial neoplasia?

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Q&A

Which cytology results predict cervical intraepithelial neoplasia?

J Fam Pract. 2003 November;52(11):828-848

By

Linda French, MD

BACKGROUND: Each year about 3 million women in the United States have cervical cytology results showing LSIL or ASCUS. Appropriate management of these cases has been the subject of some controversy. The ASCUS-LSIL Triage Study (ALTS) was a large, federally funded trial of alternative strategies for the initial management of women with mildly abnormal cytology results.
POPULATION STUDIED: Women were referred to the study from community practice if they had cervical cytology results showing ASCUS or LSIL. In most cases women referred to the study had their Pap smears obtained by traditional spatula and brush technique (n=5060; 3488 with ASCUS and 1572 with LSIL).
STUDY DESIGN AND VALIDITY: This was a carefully designed randomized controlled trial. Allocation to treatment group was concealed from the enrolling investigator. Blinding was not feasible. However, the study providers were blinded to some test results, according to the arm of the treatment. Pathology specimens were read twice as a quality-control measure.
OUTCOMES MEASURED: A secondary analysis was performed to compare cases of cytology results of HPV-positive ASCUS and LSIL and their respective risks of progression to CIN 2 or 3. The intention was to separate prevalent cases of CIN 2 and 3 from those that progressed during the 2-year follow up period. So only those women who underwent colposcopy as an initial management strategy were included. They were the women randomized to the immediate colposcopy arm of the study and those who underwent initial colposcopy based on ASCUS or LSIL with a positive HPV test. They considered a diagnosis of CIN 2 or 3 by initial colposcopy to be prevalent cases, and did recognize that a few prevalent cases of CIN 2 or 3 could have been missed at the time of initial colposcopic assessment.
RESULTS: The study included 1193 women with HPV-positive ASCUS and 897 cases of LSIL who were randomized to receive initial colposcopy. Initial assessment with colposcopy and biopsy when the study clinician considered it to be indicated demonstrated CIN 2 or 3 in 17% in each of these groups (203/1197 and 152/897). After excluding women with CIN 2 or 3 diagnosed at enrollment, in the remaining women—with CIN 1, negative biopsy, or negative colposcopy with no biopsy taken—12% in each group (107/905 and 87/682) were diagnosed with CIN 2 or 3 by the end of the 2 years of follow-up. CIN 2 or 3 was diagnosed at any time during the study in 27% of the women with HPV-positive ASCUS and 28% of women with LSIL.

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Which cytology results predict cervical intraepithelial neoplasia?

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