title: Management of patients with two consecutive ASC-US smears.
abstract: BACKGROUND
  To determine whether aggressive or expectative management of patients after two consecutive smears with atypical squamous cells of undetermined significance is preferable. To determine whether triage with high-risk human papillomavirus will identify all patients with cervical intraepithelial neoplasia grade 2 and 3.
  
  
  METHODS
  140 of 282 patients referred for colposcopy with two consecutive smears with atypical squamous cells of undetermined significance were only treated when abnormalities suggestive of high-grade cervical intraepithelial neoplasia were present at colposcopy. The other 142 patients underwent excision of all detected colposcopic abnormalities. Both groups were compared regarding the final cytological follow-up, the number of diathermy loop excisions, and the detection of cervical intraepithelial neoplasia. Retrospectively, the outcome of triage with high-risk human papillomavirus in the first group was investigated.
  
  
  RESULTS
  There was no significant difference in final cytological follow-up between patients managed by expectative or by aggressive colposcopic management. Significantly less diathermy loop excisions (p < 0.001) are performed in case of expectative management. The sensitivity, specificity, negative- and positive predictive values of triage with high-risk human papillomavirus detection were comparable with those of colposcopy alone.
  
  
  CONCLUSIONS
  Patients referred with two consecutive ASC-US smears may be followed with an expectative colposcopic management and cytological follow-up. Triage with high-risk human papillomavirus will reduce the number of referrals and colposcopies, but (cytological) follow-up remains necessary in all high-risk human papillomavirus negative patients as well.
authors.forename: R L M
authors.initials: RL
authors.lastname: Bekkers
authors.forename: A G J M
authors.initials: AG
authors.lastname: Hanselaar
authors.forename: W J G
authors.initials: WJ
authors.lastname: Melchers
authors.forename: J H M
authors.initials: JH
authors.lastname: van Schaik
authors.forename: H
authors.initials: H
authors.lastname: Boonstra
authors.forename: L F A G
authors.initials: LF
authors.lastname: Massuger
mesh_terms: D003127:Colposcopy; D005260:Female; D006801:Humans; D008499:Medical Records; D009426:Netherlands / Q000453:epidemiology; D027383:Papillomaviridae / Q000302:isolation & purification; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery* / Q000821:virology; D014626:Vaginal Smears