ISSN: 2642-116X
Authors: Warke A*, Kamal MM, Basu P, Ughade S and Singh M
Background and Objectives: Cytology screening programmes decrease the risk of cervical cancer by detecting the precancerous changes. Treating these reduce the likelihood of developing invasive disease in future. The management strategies for severe precancerous changes are well established, however, this is not the case with minor cytological abnormalities like ASCUS or LSIL especially when a triage strategy like HPV testing is not easily available. This study aims to assess whether immediate referral to colposcopy is better than cytologic surveillance for women with a cervical smear diagnosis of ASC-US and LSIL in a context where HPV test is either unavailable or not affordable. Methods: A prospective study was conducted at a tertiary care hospital between January 2021 and November 2022. Total 126 women with a Pap smear report of ASC-US or LSIL were recruited to receive either cytologic surveillance (Group A) or immediate colposcopy (Group B), with 63 women in each group. Adherence to follow up and eventual histologic diagnosis of HSIL on colposcopically directed biopsy (CDB) and/or Loop electrical excision procedure (LEEP) were considered as the main study end-point. Results: Significantly more women defaulted from the cytologic surveillance group than the immediate colposcopy group (p=0.00001). In group B, using CDB and LEEP, 5 additional high-grade lesions were detected. However, the p value was not significant when compared with the cytologic surveillance group (p=0.360). Interpretation and Conclusions: Cytologic surveillance is fraught with a poor compliance rate. In the absence of HPV DNA test, minor cytologic abnormalities should undergo immediate colposcopy if follow up cannot be ensured. The high persistence rates of ASC-US and LSIL (41.18% and 35.71%), as well as the high progression rate of LSIL in the cytologic surveillance group, also underscore the necessity for these women to undergo immediate referral to colposcopy.
Keywords: ASCUS; Cytologic Surveillance; Immediate Colposcopy; LEEP; LSIL; Pap Smears; Risk Ratio; Swede Score
