Prevalence of Abnormal Cervical Cytology based on the Bethesda System, at Phetchabun Hospital

Abstract

The objective of this study was to define the prevalence of abnormal cervical cytology based on the Bethesda System. All cytologic smears from the 1st April 2003 to the 31st March 2005 were reviewed and classified with the context of the Bethesda Classification System. Medical records of all patients with diagnoses of atypical squamous cell of undetermined significance (ASCUS), atypical glandular cell of undetermined significance (AGUS), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), squamous cell carcinoma (SCCA) or adenocarcinoma were reviewed for previous medical history, diagnostic study, histologic diagnosis and prior gynecologic disease. The most significant histologic diagnosis from all biopsy specimens submitted was compared with the abnormal cervical smear diagnostic categories in preinvasive and early stage cervical cancer. The prevalence of abnormal cervical cytology in 3,555 smears was 6.92 percent, which can be classified into ASCUS 52.03 percent (128 smears), HSİL 23.58 percent (58 smears), LSIL 11.79 percent (29 smears), squamous cell carcinoma 10.57 percent (26 smears) AGUS 1.63 percent (4 smears), and adenocarcinoma 0.40 percent (1 smear). Medical records of 223 new cases with abnormal cervical cytology were reviewed whereby 90 (40.36%) dropped out in the follow up and 39 (17.49%) underwent repeated pap smears. Colposcopes with or without biopsy were performed in 94 cases (42.15%). Cytologic diagnosis of histologically diagnosed as HSIL (CIN II or CIN III) and cancer of cervix was HSIL 82.61 percent ASCUS 13.04 percent and LSIL 4.35 percent, respectively. In conclusion the prevalence of abnormal cervical cytology in this study was slightly high relative to other studies. It is recommended that all women with HSIL cytology should undergo intensive evaluation including colposcopy with or without endocervical currettage. Failure to participate through the follow up period in Phetchabun Hospital was relatively high, Scatherefore, the existing patient call and recall system should be re-evaluated.