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Incidence and Predictors of Cervical Dysplasia in Patients With Minimally Abnormal Papanicolaou Smears

KOBELIN, MARC H. MD; KOBELIN, CINDY G. MD; BURKE, LOUIS MD; LAVIN, PHILIP PhD; NILOFF, JONATHAN M. MD; KIM, YOUNG B. MD
Obstetrics & Gynecology: September 1998
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Objective To estimate the incidence of dysplasia in patients with Papanicolaou smears showing atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesions (SIL) and to identify clinical predictors of dysplasia in these patients.

Methods Patients referred for ASCUS and low-grade SIL were reviewed retrospectively. All patients were evaluated with immediate colposcopy. A multivariate logistic regression analysis was performed to identify clinical predictors of histologic SIL and histologic high-grade SIL.

Results One hundred thirty-seven (34%) of 406 consecutive patients had histologic SIL. Regression analysis identified age (under 35 versus 35 years or above) and initial smear (low-grade SIL versus ASCUS) as statistically significant predictors of histologic SIL and high-grade SIL (P < .001). When patient outcomes were analyzed by age and initial Papanicolaou smear results, the subgroup of patients 35 years or older with ASCUS had low incidences of histologic SIL (14%) and high-grade SIL (1%). The other subgroups (under 35 years with ASCUS, under 35 years with low-grade SIL, and 35 years or older with low-grade SIL) had incidences of histologic SIL and histologic high-grade SIL of at least 28% and 14%, respectively.

Conclusion The high incidence of dysplasia in patients with minimally abnormal Papanicolaou smears suggests that immediate colposcopy might be appropriate for many of these patients. Age and initial Papanicolaou smear are predictive of dysplasia and might be used to select patients who have low incidence of dysplasia and might not require immediate colposcopy.

Address reprint requests to: Marc H. Kobelin, MD, Beth Israel Deaconess Medical Center, Department of Obstetrics and Gynecology, 330 Brookline Avenue, Boston, MA 02215

© 1998 The American College of Obstetricians and Gynecologists