Managing cellular abnormalities

A. Atypical squamous cells of undetermined significance (ASCUS). On retesting, 25%-60% of patients will hsve LSIL or HSIL, and 15% will demonstrate HSIL. In a low-risk patient, it is reasonable to offer the option of repeating the cervical smears every 4 months for the next 2 years--with colposcopy, endocervical curettage (ECC) and directed biopsy if findings show progression or the atypical cells have not resolved. Alternatively, the patient can proceed immediately with colposcopy, ECC, and directed biopsy. In a high-risk patient (particularly when follow-up may be a problem), it is advisable to proceed with colposcopy, ECC, and directed biopsy.

B. Low-grade squamous intraepithelial lesion (LSIL). The smear will revert to normal within 2 years in 30%-60% of patients. Another 25% have, or will progress to, moderate or severe dysplasia (HSIL). With a low-risk patient, cervical smears should be repeated every 4 months for 2 years; colposcopy, ECC, and directed biopsy are indicated for progression or nonresolution. In the high-risk patient, prompt colposcopy, ECC, and directed biopsy are recommended.

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