Risks of cervical intraepithelial neoplasia grade 3 or invasive cancers in ASCUS women with different management: a population-based cohort study

Yi Jou Tai, Yun Yuan Chen, Huang Cheng Hsu, Chun Ju Chiang, San Lin You, Chi An Chen, Wen Fang Cheng, Taiwan Cervical Cancer Control Task Force, Yi Jou Tai, Yun Yuan Chen, Huang Cheng Hsu, Chun Ju Chiang, San Lin You, Chi An Chen, Wen Fang Cheng, Taiwan Cervical Cancer Control Task Force

Abstract

Objective: To investigate the progression risk of atypical squamous cells of undetermined significance (ASCUS) with different clinical managements.

Methods: Women with their first diagnosis of ASCUS cytology were retrieved from the national cervical cancer screening database and linked to the national health insurance research database to identify the management of these women. The incidences of developing cervical intraepithelial neoplasia grade 3 and invasive cervical cancer (CIN3+) were calculated, and the hazard ratios (HRs) were estimated using a Cox proportional hazards model. This study was approved by the Research Ethics Committee of the National Taiwan University Hospital and is registered at ClinicalTrials.gov (Identifier: NCT02063152).

Results: There were total 69,741 women included. Various management strategies including colposcopy, cervical biopsies and/or endocervical curettage, and cryotherapy, failed to reduce the risk of subsequent CIN3+ compared with repeat cervical smears. Loop electrosurgical excision procedure/conization significantly decreased risk of subsequent CIN3+ lesions (HR=0.22; 95% confidence interval [CI]=0.07-0.68; p=0.010). Women in their 40s-50s had an approximately 30% risk reduction compared to other age groups. Women with a previous screening history >5 years from the present ASCUS diagnosis were at increased risk for CIN3+ (HR=1.24; 95% CI=1.03-1.49; p=0.020).

Conclusion: In women of first-time ASCUS cytology, a program of repeat cytology can be an acceptable clinical option in low-resource settings. Caution should be taken especially in women with remote cervical screening history more than 5 years.

Keywords: Atypical Squamous Cells of Undetermined Significance; Cervical Biopsy; Cervical Intraepithelial Neoplasia Grade III; Colposcopy; Cryotherapy; Uterine Cervical Neoplasms.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Copyright © 2018. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology.

Figures

Fig. 1
Fig. 1
Flow of the study population among all women who attended cervical cancer screening with ASCUS cytology during 2004–2007. ASCUS, atypical squamous cells of undetermined significance; CIN3+, cervical intraepithelial neoplasia grade 3 and invasive cervical cancer; ECC, endocervical curettage; LEEP, loop electrosurgical excision procedure.
Fig. 2
Fig. 2
Survival analysis of subsequent risk for CIN3+ diagnosis in 69,741 women with ASCUS cytology according to management. X-axis refers to follow-up time in months since 1 year after the ASCUS cytology. Y-axis refers to cumulative incidence of subsequent CIN3+. ASCUS, atypical squamous cells of undetermined significance; CIN3+, cervical intraepithelial neoplasia grade 3 and invasive cervical cancer; ECC, endocervical curettage; LEEP, loop electrosurgical excision procedure.

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