title: Colposcopy Requirement of Papanicolaou Smear after Atypical Squamous Cells of Undetermined Significance (ASC-US) by Follow-up Protocol in an Urban Gynaecology Clinic, a Retrospective Study in Thailand.
abstract: BACKGROUND
  ASC-US cases are managed according to the current American Society for Colposcopy and Cervical Pathology (ASCCP) guideline in which a human papillomavirus (HPV) test and repeat Pap smear are performed in the next 1 year. Colposcopy in cases of positive high risk HPV and persistent ASC-US or more in subsequent Pap smear is recommended. The HPV test is more expensive and still not currently a routine practice in Thailand.
  
  
  OBJECTIVE
  To identify the risk factors of persisted abnormal Pap smear and the colposcopic requirement rate in women with ASC-US.
  
  
  METHODS
  During 2008-2013, this study was conducted in Prapokklao Hospital, Chanthaburi, Thailand. Participants were women who attended gynaecology clinic for cervical cancer screening. Women who had cytological reports with ASC-US were recruited. During the study period, 503 cases were enrolled. Colposcopic requirement was defined as those who were detected with an ASC-US or more in subsequent Pap smears up to 1 year follow-up.
  
  
  RESULTS
  The colposcopic referral rate was 23.2 (85/365) percent at 12 months. Prevalence of cervical intraepithelial neoplasia (CIN) 2/3 was 3.3 (12/365) percent. Loss follow-up rate of subsequent Pap smear and colposcopic appointment were 27.4 (138/503) and 48.2 (41/85) percent, respectively. There was no invasive cancer. High risk factors for persisted abnormal Pap smears in subsequent test were premenopausal status, HIV infected patients and non-oral contraceptive pills (COC) users.
  
  
  CONCLUSIONS
  Referral rate for colposcopy in women with ASC-US reports was rather high. Loss to follow-up rate was the major limitation. Immediate colposcopy should be offered for women who had high risk for silent CIN.
authors.affiliation: Department of Obstetrics and Gynaecology, Prapokklao Hospital, Chanthaburi, Thailand E-mail : panysanan@yahoo.com.
authors.forename: Thitichaya
authors.initials: T
authors.lastname: Perksanusak
authors.forename: Panya
authors.initials: P
authors.lastname: Sananpanichkul
authors.forename: Watcharin
authors.initials: W
authors.lastname: Chirdchim
authors.forename: Kornkarn
authors.initials: K
authors.lastname: Bhamarapravatana
authors.forename: Komsun
authors.initials: K
authors.lastname: Suwannarurk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065309:Atypical Squamous Cells of the Cervix / Q000473:pathology*; D003127:Colposcopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006176:Gynecology / Q000379:methods; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test / Q000379:methods; D027383:Papillomaviridae / Q000235:genetics; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000473:pathology; D012189:Retrospective Studies; D012306:Risk; D013785:Thailand; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000473:pathology; D014626:Vaginal Smears / Q000379:methods; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000473:pathology