The clinical significance of ASCUS and AGUS in Pap smear

Park, Hee Jin; Kim, Dong Kyu; Kim, Jae Wook; Kim, Jung Han; Jang, Si Young

Abstract

OBJECTIVE
This study was undertaken to evaluate the clinical significance of ASCUS and AGUS in routine Papanicolaou smears. METHOD: A review of retrospective medical records was conducted on 267 women whose Papanicolaou smears yielded diagnoses of either ASCUS or AGUS from March, 1998 to December, 2000 at Youngdong Severance Hospital. RESULT: The incidences of ASCUS and AGUS on PAP smears are 1.3%(258 cases) and 0.1%(23 cases). Of these, 89 cases with ASCUS and 9 cases with AGUS had subsequent cervical biopsies. The biopsy cases with ASCUS showed 68(74.4%) cervicitis, 2(2.2%) hyperkeratosis, 1(1.1%) condyloma, 9(9.9%) CIN 1, 5(5.5%) CIN 2, 1(1.1%) CIN 3, 2(2.2%) microinvasive squamous cell carcinoma and 1(1.1%) adenocarcinoma. Those with AGUS showed 6(6.6%) cervicitis, 1(1.1%) CIN 2, 1(1.1%) CIN 3, 1(1.1%) endometrial cancer. Women under 35 year-old(P=0.012) or who had coital history in younger periods(before 20 years old, P=0.014) had much higher frequency of high grade lesion. The overall incidence of HSIL was higher in the group with ASCUS favoring SIL than in the group with unqualified ASCUS. (P=0.042) The group with AGUS also had much higher frequency of high grade lesion than the group with ASCUS. (P=0.043)
CONCLUSION
Immediate colposopic evaluation should be performed for AGUS and ASCUS favoring SIL. Regarding ASCUS, high risk patients who are under 35 years old or who have early coital history(< 20 yrears old) also should undergo colposcopic examination. With the exception of the aboves, we propose HPV screening and HPV DNA testing for intermediate screening test.