To evaluate the clinical significance and management of patients with Atypical Squamous Cells of Undetermined Significance (ASCUS) and Low-grade Squamous Intraepithelial Lesion (LSIL).

Pathologic reports of 5752 patients who have underwent cervical Pap smear screening were reviewed at Dong-A university hospital from November 2000 to February 2002. Cytologic diagnosis was classified by the TBS. Of these patients, 63 women with ASCUS and LSIL were followed by repeat Pap smear, colposcopy-directed punch biopsy, cone biopsy and hysterectomy.

The rate of abnormal cytology was 4.2%, with 1.1% of ASCUS, 0.1% of AGUS, 1.1% of LSIL, 1.1% of HSIL, and 0.8% of SCC. The ratio of ASCUS/SIL was 1.97. Of the 35 patients who had a cervical cytologic diagnosis of ASCUS, 9 patients (25.8%) were above dysplasia, 25 (71.4%) were normal or benign changes, and 1 (2.8%) was ASCUS. The 62 cases had diagnosed LSIL by TBS. Of these patients, 28 cases were follow up with repeat smear and/or cervical biopsy. They showed WNL or BCC in 15 cases (53.5%), chronic cervicitis in 3 (10.7%), ASCUS in 1 (3.6%), CIN I in 1 (3.6%), koilocytic atypia in 1 (3.6%), condyloma in 1 (3.6%), and LSIL in 6 (21.4%).

Most of ASCUS or LSIL revealed negative for malignancy, usually conservative management such as repeat Pap smear is desirable. But this study showed that a cytologic diagnosis of ASCUS was associated with SIL and cancer in one fourth. So further active management such as colposcopic directed biopsy is required.