자궁경부세포진에서 ASCUS, LSIL, HSIL의 세포조직학적 상관성과 임상적 의의

초록

Objective : To evaluate the cytohistologic correlation and the clinical significance among patients with atypical squamous cells of undetermined significance(ASCUS), low-grade squamous intraepithelial lesion(LSIL), and high-grade squamous intraepithelial lesion(HSIL) identified on cervical Pap smear screening. Materials and Methods : Pathologic reports of patients who have underwent cervical Pap smear screening at Korea university Ansan hospital from January 1997 to December 1998 were evaluated. Cytologic diagnosis was classified by the Bethesda System (TBS). Among these patients, the patients whose histologic diagnosis was established by cervical punch biopsy, LEEP, conization, and hysterectomy were targetted. Cytohistologic correlation were analysed in ASCUS, LSIL, and HSIL respectively. Results : During 2 year period (1997-1998), total 3587 Pap smears were taken. The median rate of abnormal cytology was 7.2%, with 4.6% of ASCUS, 0.8% of LSIL, 1.3% of HSIL, and 0.5% of squamous cell carcinoma. The median ratio of ASCUS versus SIL was 2.2. Smears with ASCUS showed 46.9% with chronic cervicitis, 40.6% with LSIL(35.9% with koilocytotic atypia, 4.7% with mild dysplasia), 10.9% with HISL, and 1.6% with invasve squamous cell carcinoma on biopsy. Smears with LSIL showed 38.1% with LSIL(9.5% with koilocytotic atypia, 28.6% with mild dysplasia), and 28.6% with HSIL on biopsy. Smears with HSIL showed 27.8% with LSIL, 63.9% with HSIL, and 8.3% with invasive squamous cell carcinoma on biopsy. Conclusion : Smears with ASCUS showed 53.1% with SIL and cancer on biopsy. But most of theses cases revealed koilocytotic atypia rather than dysplasia, so conservative management such as repeated Pap smear is desirable. On the other hand, because smears with LSIL showed dysplasia rather than koilocytotic atypia on biopsy, more active management such as colposcopic directed biopsy is required.

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