Northern Thai Women with High Grade Squamous Intraepithelial Lesion on Cervical Cytology Have High Prevalence of Underlying Invasive Carcinoma

The aim of this study was to determine the underlying pathology of women with high grade squamous intraepitheliallesion (HSIL) on cervical cytology. A total of 681 women with HSIL cytology undergoing colposcopic examination atChiang Mai University Hospital (CMUH) between January 2000 and December 2005 were evaluated for the underlyingcervical pathology. The final pathology was diagnosed from the most severe lesions obtained by punch biopsy, loopelectrosurgical procedure, cold knife conization or hysterectomy. Underlying high grade cervical lesions includingcervical intraepithelial neoplasia grade 2, 3 and adenocarcinoma in situ were noted in 502 (73.7%) women. Invasivecervical carcinoma was identified in 141 (20.7%). The remaining 38 (5.6%) had either low grade or no intraepitheliallesions. No significant difference in the prevalence of underlying high grade and invasive lesions was noted betweenwomen with cytologic diagnosis of HSIL from CMUH and other hospitals. In conclusion, northern Thai women withHSIL cytology are at significant risk of having underlying severe cervical lesions, and especially invasive carcinomawhich is detected in approximately one-fifth of the cases.     

CCNA1 Promoter Methylation: a Potential Marker for Grading Papanicolaou Smear Cervical Squamous Intraepithelial Lesions

Background: From our previous study, we established that cyclin A1 (CCNA1) promoter methylation isstrongly correlated with multistep progression of HPV-associated cervical cancer, suggesting potential use as adiagnostic maker of disease. Objectives: The purpose of the present study was to assess the prevalence of CCNA1promoter methylation in residual cervical cells isolated from liquid-based cytology that underwent hrHPV DNAscreening for cervical cancer, and then to evaluate this marker for diagnostic accuracy using parameters likesensitivity, specificity, predictive values and likelihood ratio. Methods: In this retrospective study, histopathologywas used as the gold standard method with specimens separated into the following groups: negative (n=31), lowgradesquamous intraepithelial lesions (LSIL, n=34) and high-grade squamous intraepithelial lesions or worse(HSIL+, n=32). The hrHPV was detected by Hybrid Capture 2 (HC2) and CCNA1 promoter methylation wasexamined by CCNA1 duplex methylation specific PCR. Results: The results showed the frequencies of CCNA1promoter methylation were 0%, 5.88% and 83.33%, while the percentages of hrHPV were 66.67%, 82.35% and100% in the negative, LSIL and HSIL+ groups, respectively. Although hrHPV infection showed high frequencyin all three groups, it could not differentiate between the different groups and grades of precancerous lesions. Incontrast, CCNA1 promoter methylation clearly distinguished between negative/LSIL and HSIL+, with high levelsof all statistic parameters. Conclusion: CCNA1 promoter methylation is a potential marker for distinguishingbetween histologic negative/LSIL and HSIL+using cervical cytology samples.     

Cervical smear interpretations in women with a histologic diagnosis of severe dysplasia: factors associated with discrepant interpretations

BACKGROUND: Because most low-grade squamous intraepithelial lesions (LSIL) regress spontaneously, the appropriate follow-up of women with a cytologic diagnosis of LSIL has engendered discussion. This retrospective study was undertaken to assess the feasibility of limiting colposcopy to women with cytologic interpretations of high-grade squamous intraepithelial lesions (HSIL) in a high-risk population. METHODS: The pathology computer files (including files from January to December 1997) of The University Hospital, University of Oklahoma Health Sciences Center, revealed 197 women whose histologic samples were coded as severe dysplasia. Of these, 138 had a cervical smear interpreted in our laboratory before the colposcopic visit. On review, the tissue samples of 119 women met consensus criteria for severe dysplasia. RESULTS: Original cytologic diagnoses for 119 cytologic smears included 80 (62.7%) that were interpreted as HSIL. After retrospective review, 28 cases with LSIL or less were reclassified as HSIL and were considered to be discrepant for the purpose of this study. Major confounding factors in the original categorization include lack of consistency among the pathologists for the interpretation of metaplastic patterns and specimen adequacy, particularly air-drying artifact. Eleven cases (10.2%) did not have cells identifiable as HSIL because of sampling error and/or severe air-drying artifact. CONCLUSIONS: These results indicate that a substantial number of histologically verified cases of severe dysplasia can have a smear interpretation of LSIL or less. The factors that hampered recognition of the true severity of the lesion in this series were identified and tabulated.     

Accuracy of colposcopically directed biopsy in diagnosis of cervical pathology at Srinagarind Hospital

Objective: To determine the accuracy of colposcopically directed biopsy (CDB) in diagnosis of precancerous or cancerous lesion of the uterine cervix as a quality index of the institute. Materials and Methods: We retrospectively reviewed the medical records of the women who had colposcopic examination at the Department of Obstetrics and Gynecology, Srinagarind Hospital from January, 2005 to December, 2010. The women with satisfactory colposcopic examination who had CDB and further interventions such asloop electrosurgical excision procedure (LEEP)/conization, and/or hysterectomy were included in study. The pathological reports of the specimens from CDB were analyzed comparing with LEEP/conization or hysterectomy according to the highest degree of abnormalities. Pathological reports of HSIL (high grade squamous intraepithelial lesion) or more severe wereclassified as positive, while LSIL (low grade squamous intraepithelial lesion) or less severe were classified as negative. Results: There were 320 patients included, 259 having highest pathological reports of HSIL or more. The accuracy of CDB to detect HSIL or more of the uterine cervix was 87.8% with sensitivity, specificity, PPV and NPV of 84.9%, 100%, 100%, and 61%, respectively. Conclusions: The accuracy of CDB in diagnosis of cervical pathology in our institute was acceptable and comparable to those of others. CDB is a reliable method to obtain the pathological diagnosis in women with abnormal cervical cytologic screening.     

Clinical significance of the diagnosis of low‐grade squamous intraepithelial lesion,cannot exclude high‐grade squamous intraepithelial lesion

BACKGROUND:

The diagnosis of low‐grade squamous intraepithelial lesion (LSIL), cannot exclude high‐grade squamous intraepithelial lesion (LSIL‐H) was not included in the 2001 Bethesda System. It is used in some institutions to diagnose cases that fulfill criteria for both the diagnosis of LSIL and atypical squamous cells, cannot exclude high‐grade squamous intraepithelial lesion (ASC‐H). In this study, the authors reviewed their experience with cases reported as LSIL‐H during a 4‐year interval.

METHODS:

Clinical information and histologic follow‐up data were retrieved for Papanicolaou (Pap) tests (PTs) that were diagnosed as LSIL‐H, LSIL, ASC‐H and high‐grade squamous intraepithelial lesion (HSIL) from January 1, 2004 to December 31, 2007.

RESULTS:

Of 235,645 PTs (97% SurePath) that were processed during the study period, the laboratory diagnosed 0.52% as ASC‐H, 2% as LSIL, 0.30% as LSIL‐H, and 0.39% as HSIL. Biopsy follow‐up was available for 47%, 49%, 56.7% and 74% of these cases, respectively. Cervical intraepithelial neoplasia 2 (CIN‐2) and CIN‐3 or more severe lesions (CIN‐3+) were identified on follow‐up cervical biopsy more often in women who had diagnoses of LSIL‐H and ASC‐H (33.14% and 26.33%, respectively) than in women who had a diagnosis of LSIL (16.11%).

CONCLUSIONS:

The similarity of histologic follow‐up results between LSIL‐H and ASC‐H suggested that the management of women who have a diagnosis of LSIL‐H should be similar to the management of women who have a diagnosis of ASC‐H. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.     

Performance of HPV DNA Testing with Hybrid Capture 2 in Triaging Women with Minor Cervical Cytologic Abnormalities (ASC-US/LSIL) in Northern Thailand

Background: Minor cervical cytologic abnormalities include atypical squamous cells of undeterminedsignificance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL). Approximately 10-20% of womenwith minor cytologic abnormalities have histologic high-grade squamous intraepithelial or worse lesions (HSIL+).In Thailand, women with minor cytologic abnormalities have a relatively high risk of cervical cancer, and referralfor colposcopy has been suggested. A triage test is useful in the selection of women at risk for histologic HSIL+ toreduce the colposcopy burden. The aim of this study was to assess the performance of high-risk HPV DNA test intriage of women with minor cytologic abnormalities in northern Thailand. Materials and Methods: All womenwith ASC-US/LSIL cytology who were referred to our colposcopy clinic from October 2010 to February 2014were included. HPV DNA testing was performed using Hybrid Capture 2 (HC2). All patients received colposcopicexamination. Accuracy values of HC2 in predicting the presence of histologic HSIL+ were calculated. Results:There were 238 women in this study (121 ASC-US and 117 LSIL). The HC2 positivity rate was significantlyhigher in the LSIL group than in ASC-US group (74.8% versus 41.0%, p<0.001). Histologic HSIL+ was detectedin 9 women (7.4%) in the ASC-US group and 16 women (13.7%) in the LSIL group (p=0.141). There was nohistologic HSIL+ detected among HC2-negative cases (sensitivity and negative predictive value of 100%). Theperformance of HC2 triage was highest among women aged >50 years with ASC-US cytology. An increase in thecut-off threshold for positive HC2 resulted in a substantial decrease of sensitivity and negative predictive value.Conclusions: HPV DNA testing with HC2 shows very high sensitivity and negative predictive value in triage ofwomen with minor cervical cytologic abnormalities in northern Thailand. An increase of the cut-off thresholdfor HC2 triage is not recommended in this region.     

维吾尔族妇女宫颈病变病理进程与降钙素相关肽α表达的关系

目的：观察降钙素相关肽α（calcitonin-related polypeptide alpha,CALCA）的蛋白表达水平与宫颈病变病理进程的关系。方法：收集维吾尔族妇女宫颈炎、低度鳞状上皮内瘤变（LSIL）、高度鳞状上皮内瘤变（HSIL）和宫颈鳞癌（CSCC）患者的石蜡包埋组织标本共104例,采用免疫组织化学方法检测CALCA蛋白的表达水平。结果：CALCA蛋白在大部分宫颈炎患者的宫颈上皮细胞中强表达,但是随着宫颈上皮内瘤变和宫颈癌的发生,其表达水平呈现从强表达到弱表达或表达缺失的趋势改变,且与宫颈病变病理进程呈负相关（r=-0.361,P〈0.01）,其中宫颈炎、LSIL、HSIL和CSCC组患者的CALCA蛋白表达缺失率分别为45.5%（15/33）、75%（12/16）、80.8%（21/26）和82.8%（24/29）,C ALCA蛋白表达缺失率在HSIL及CSCC与宫颈炎间的差异具有统计学意义（P〈0.01）,而在LSIL与宫颈炎间的差异无统计学意义（P〉0.05）。结论：CALCA蛋白表达缺失与维吾尔族妇女宫颈癌前病变及癌症的发生有一定的关系。     

Assessment of Cervical Cytological Data in Albanian Females

Background: Cervical cancer is one of the most common female malignancies with high mortality ratesin developing countries. Our purpose was to determine the prevalence of cervical cytological abnormalitiesby cervical cytology (CC) and the analysis of risk factors in Albanian population. Materials and Methods: Atotal of 5,416 conventional pap smear tests collected between January 2009 and January 2012 from TiranaUniversity Hospital Obstetrics-Gynecology “Queen Geraldine” were retrospectively analyzed. Results: A totalof 258 (4.8%) cases had epithelial abnormalities. The numbers and rates were as follows: atypical squamous cellof undetermined significance (ASCUS; n=150 [2.76%]); atypical glandular cells of undetermined significance(AGUS; n=8 [0.14%]); low-grade squamous intraepithelial lesion (LSIL; n=87 [1.6%]); high- grade squamousintraepithelial lesion (HSIL; n=10 [0.18%]); and squamous cell carcinoma (SCC; n=3 [0.05%]). Conclusions:The prevalence of cervical cytological abnormality in our study was 4.8%. A larger community-based study mayestablish the exact prevalence of malignant and premalignant lesions, so as to plan for future screening.     

Diagnostic Value of Endocervical Curettage for DetectingDysplastic Lesions in Women with Atypical Squamous Cells of Undetermined Significance (ASC-US) and Low Grade Squamous Intraepithelial Lesion (LSIL) Papanicolaou Smears

Background: To determine the frequency of dysplastic lesions in the endocervical curettage (ECC) specimensof women with ASC-US and LSIL Pap and to evaluate the possible factors associated with high grade dysplasia inthose ECC specimens. Materials and Methods: Two hundred and sixty patients with ASC-US and LSIL cytologicsmears who underwent an ECC at the time of colposcopic examination during January 2010 and December2012 were reviewed. Demographic and clinicopathologic data were collected. Multivariate analysis using binarylogistic regression was used to identify factors that might be associated with high grade endocervical dysplasia.Results: The frequency of endocervical dysplasia was 7.7% (20 out of 260 patients). Cervical intraepithelialneoplasia (CIN) 1 and CIN 2-3 lesions in the endocervical canal were observed in 12 and 8 patients, respectively.No microinvasive or invasive cervical cancers were identified. There was no difference in the frequency of highgrade endocervical dysplasia between the patients with satisfactory and unsatisfactory colposcopic examinations(1.4% vs 5.1%, respectively, p=0.087). A multivariate logistic regression analysis demonstrated a significantassociation between high grade CIN on ectocervical biopsy as well as LSIL cytologic smears and high gradedysplasia in endocervical canal (OR=0.046, 95%CI=0.007-0.288; p=0.001 and OR=0.154, 95%CI=0.025-0.942;p=0.043, respectively). Conclusions: The frequency of high grade endocervical dysplasia in women with ASC-USand LSIL cytologic smears was low. Therefore, routine performance of ECC in those women is debatable. Highgrade ectocervical dysplasia and LSIL cytologic smears may be used as predictors for high grade dysplasia inendocervical canal and ECC in these patients is reasonable.     

液基薄层细胞学检测子宫颈病变4234例临床病理分析

 目的　评价液基薄层细胞学检测（TCT）在子宫颈病变筛查中的意义。方法　采用TCT系统采集子宫颈细胞学标本4234例,按照TBS系统（the Besthesda system） 进行判读。对细胞学筛查为异常的272例[意义不明确的非典型性鳞状细胞（ASC-US）或以上病变]进行阴道镜下活组织病理检查。结果　TCT与阴道镜下活组织病理检查结果符合率为低度鳞状上皮内病变（ LSIL）85.71 %（12／14）、高度鳞状上皮内病变（HSIL）100 %（20／20）、鳞状细胞癌（ SCC）75.00 %（3／4）、腺癌（AC）100 %（2／2）。TCT诊断不除外高级别鳞状上皮内病变的非典型性鳞状细胞（ASC-H）以上病变的阳性率为23.16 %（63／272）,活检病理组织学诊断子宫颈上皮内瘤样低度病变（CINⅠ）以上病变的阳性率为24.26 %（66／272）,二者比较差异无统计学意义（χ2＝0.868,P＝0.581）。结论　TCT与活组织病理检查诊断有较高的符合率,二者结合能大大提高对子宫颈的高度病变和子宫颈癌的检出率,减少漏诊。TCT可作为子宫颈癌及癌前病变筛查的一种高效、便捷的方法。     

液基薄层细胞学检测联合宫颈活检对诊断宫颈鳞状上皮病变的临床价值

目的:探讨液基薄层细胞学检测(liquid-based thinPrep cytology test,TCT)联合宫颈活检对诊断宫颈鳞状上皮病变的临床价值.方法:应用TCT对30350例受检者进行宫颁细胞学检查,细胞学检查结果为鳞状上皮异常者,进行阴道镜活检及病理检查.结果:TCT检出鳞状上皮异常者1 824例(6.01％),其中无明确意义的不典型鳞状细胞(atypical squamous cells of undetermined significance,ASC-US)1423例,不除外高度鳞状上皮病变的不典型鳞状细胞(atypical squamous cells cannot exclude high grade intraepithelial lesion,ASC-H)214例,低度鳞状上皮内病变(low grade squamous intraepithelial lesion,LSIL) 92例,高度鳞状上皮内病变(high grade squamous intraepithelial lesion,HSIL) 80例,鳞状细胞癌(squamous cell carcinoma,SCC) 15例.与活检病理检测结果相比,1423例ASC-US中,宫颁上皮内瘤样病变-Ⅰ级(grade Ⅰ cervical intraepithelial neoplasia,CIN-Ⅰ)202例、CIN- Ⅱ和CIN- Ⅲ 22例、SCC 1例;214例ASC-H中,CIN-Ⅰ 12例、CIN-Ⅱ和CIN-Ⅲ 101例、SCC5例:LSIL、HSIL及SCC组中与组织病理检测结果的符合率分别为63.04％( 58/92)、81.25％ (65/80)及100％( 15/15),SCC组和HSIL组的组织学符合率高于LSIL组(P＜0.01).结论:TCT与阴道镜活检病理检测结果有较高的符合率,二者联合能提高宫颈癌前病变及癌变的检出率.     

Can Self Vaginal Douching for High Risk HPV Screening Replace or Assist Efficacy of Cervical Cancer Screening?

Objective: To study the accuracy of self vaginal douching and collection for HPV types 16, 18, 31 and 33 inwomen visiting Thammasat Hospital for the explicit purpose of cervical screening. Methods: A pelvic examinationand Pap smear were performed for all women who came for cervical screening. Specimens were also collected byself vaginal douching before cervical screening and sent to the cell and molecular biology laboratory for analysisof human papillomavirus (HPV) types 16, 18, 31 and 33 using the polymerase chain reaction (PCR). Results:HPV prevalence was 3.6% overall from 250 women in this study. Twenty-four (9.6%) women had an abnormalcytology screening result. No cancer was found. Four women had a high grade squamous intraepithelial lesion(HSIL) and 14 had a low grade squamous intraepithelial lesion (LSIL) from colposcopic biopsy. Self vaginaldouching for HPV 16, 18, 31 and 33 was used to predict abnormal Pap smear. Sensitivity, specificity, positivepredictive value (PPV) and negative predictive value (NPV) were 12.5%, 97.5%, 33.3% and 91.3%, respectively.Conclusion: From our analysis of self vaginal douching for HPV detection using cases from Thammasat universityhospital, it cannot replace the Pap smear.     

Incidence rate of cervical cancer and precancerous lesions in East Azarbayjan, Iran

Background: Most of deaths from cervical cancer occur in low and medium income countries and opportunistic screening for cervical cancer does not decrease the incidence rate, thus organized mass screening is needed for control of the disease. Methods: Pathology reports of cervical smears, biopsies, endocervical curettings, and hysterectomy specimens were collected from 22 pathology centers in East Azarbayjan during 2003–2004. Incidence rates for low‐grade squamous intraepithelial lesion (LSIL), high‐grade squamous intraepithelial lesion (HSIL) and cervical carcinoma were calculated by (Incidence/Population at risk) ×100 000. At risk population for cervical intraepithelial neoplasia (CIN) (between 18 and 64 years old) and invasive carcinoma of the cervix (between 30 and 64 years old) were 1 103 109 and 537 217 respectively. Result: The adjusted incidence rates for LSIL, HSIL and cervical carcinoma were 3.68, 1.19 and 5.11 per 100 000 women at risk, respectively. Conclusion: In contrast to developed countries we identified a higher incidence rate of cervical invasive cancers than preinvasive lesions, therefore, the importance and necessity of well organized mass screening in our country must be emphasized.     

DNA定量分析用于宫颈癌及癌前病变的早期筛查探讨

[目的]探讨用DNA定量分析和常规细胞学相结合方法而诊断宫颈癌及癌前病变。[方法]对3266名妇女用宫颈刷取材,每例液基薄层制片2张,1张巴氏染色做常规细胞学检查,1张Feulgan DNA染色用全自动DNA倍体分析系统做DNA定量测定。常规细胞学和DNA倍体分析系统可疑的妇女在阴道镜下行宫颈组织学活检。[结果]3266例宫颈癌标本中,常规细胞学发现42例非典型鳞状上皮（ASCUS）,9例低级别鳞状上皮内病变（LSIL）及1例高级别鳞状上皮内病变（HSIL）。DNA倍体分析发现3个或3个以上〉5C细胞的35例。32例活检病例中有14例宫颈上皮内瘤变2（CIN2）或CIN2以上级别改变,这14例细胞标本中均可见DNA倍体异常,而常规细胞学发现1例正常,8例ASCUS,4例LSIL和1例HSIL。[结论]DNA倍体分析与常规细胞学相结合方法可提高宫颈癌及癌前病变的阳性率。     

Reflex Human Papillomavirus Test Results as an Option for the Management of Korean Women With Atypical Squamous Cells Cannot Exclude High‐Grade Squamous Intraepithelial Lesion

Background.

Current guidelines recommend initial colposcopy with biopsy regardless of human papillomavirus (HPV) test results in women with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H). The purpose of this study was to evaluate the value of HPV testing in women with ASC-H based on colposcopic pathology results.

Materials and Methods.

A multicenter cross-sectional study was carried out at three academic hospitals and involved 40,847 Korean women who underwent cervical cancer screening with cytology and HPV tests with or without subsequent colposcopic biopsies between January 2007 and December 2013.

Results.

ASC-H was diagnosed in 276 women (0.7%). Only 6 of 68 (8.8%) women with ASC-H who were HPV negative had cervical intraepithelial neoplasia grade ≥2 (CIN ≥2) lesions, whereas 47.4% of the women with ASC-H who were HPV positive had CIN ≥2 lesions. No cases of invasive cervical cancer were diagnosed among women with ASC-H who were HPV negative. Logistic regression analysis was performed using the group with normal Papanicolaou test results and HPV-negative status as the reference group. Women with ASC-H who were HPV positive had a significantly increased risk of CIN ≥2 lesions, whereas no significant increase was observed in patients with ASC-H and HPV-negative status.

Conclusion.

If the result of the HPV test was negative, the risk of CIN ≥2 lesions in Korean women with ASC-H cytology was low. Reflex HPV testing should be an option for the management of women with cytology showing ASC-H to decrease unnecessary colposcopic biopsies, which are expensive and invasive.

Implications for Practice:

Current American Society for Colposcopy and Cervical Pathology guidelines recommend universal colposcopy for the management of women with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) on cytology, regardless of human papillomavirus (HPV) test results. The present study suggested that HPV cotesting in patients with ASC-H cytology can provide more detailed and useful information regarding the risk of high-grade cervical intraepithelial neoplasia (CIN) lesions and the need for further treatment. When the result of the HPV test was negative, the risk of CIN lesions of grade ≥2 in women with ASC-H cytology was low. Consequently, reflex HPV testing, rather than immediately performance of invasive and expensive colposcopy with biopsy, should be an option for the management of women with ASC-H.     

1997例宫颈管刮术结果分析

目的　探讨宫颈管刮术 (ECC)在诊断宫颈癌及癌前病变中的价值 ,以及阴道镜检时常规行ECC的必要性。方法　对宫颈癌高发地区 35～ 4 5岁妇女共 1997人行宫颈细胞学涂片、阴道镜检查及多点活检 ,活检后常规行ECC。结果　ECC的总阳性率为 1.6 % ,其中细胞学阴性者的ECC阳性率为 0 .3% ,细胞学阳性者为 5 .3% ,细胞学异常程度越高 ,ECC阳性率越高。阴道镜检不满意者的ECC阳性率为 9.1% ,阴道镜检满意者为 1.3% ,二者差异有显著性 (P <0 .0 1)。阴道镜检阴性者ECC阳性率为 0 .6 % ,镜下诊断为低度鳞状上皮内病变 (LSIL)者的ECC阳性率为 0 .9% ,高度鳞状上皮内病变 (HSIL)者为 2 4 .1% ,镜检阴性及LSIL者的ECC阳性率显著低于HSIL者。宫颈活检病理为LSIL者的ECC阳性率为 3.3% ,HSIL者为 2 2 .2 % ,鳞癌者为 5 0 .0 % ,三者间差异有显著性。 316例细胞学阳性而阴道镜检未见异常 ,其中 8例 (2 .5 % )ECC阳性 ,8例中 3例细胞学为高度病变。结论　细胞学诊断为HSIL或有更严重的病变时 ,应常规行ECC ;阴道镜检为高度病变者应行ECC ;细胞学阳性而阴道镜检不满意的患者须行ECC。     

Histopathological Outcomes of Women with Squamous Cell Carcinoma on Cervical Cytology

The aim of this study was to determine the final histopathological outcome for women with a squamous cellcarcinoma (SCCA) diagnosed by cervical cytology. The medical records and computerized colposcopic database ofpatients with SCCA on cytology who underwent colposcopy at Chiang Mai University Hospital between February2003 and December 2005 were reviewed and 48 women with SCCA cytology were identified (mean age 50 years,range 31-73). Nineteen (39.6%) women were postmenopausal. Unsatisfactory colposcopy was noted in 42 (87.5%).Thirty one (64.6%) of the patients had a final pathological diagnosis of high-grade squamous intraepithelial lesions(HGSIL), whereas only 16 (33.3%) had invasive cancer. The remaining one patient had a low-grade squamousintraepithelial lesion. Sensitivity and specificity of colposcopic examination for predicting invasive cancer was 50%and 78%, respectively. In conclusion, most women with a SCCA on cervical cytology have high-grade cervical lesionson final pathology, with only one third demonstrating invasive cancer. The loop electrosurgical excision procedure(LEEP) remains an important measure for combined treatment and diagnosis.     

子宫颈高级别鳞状上皮内病变的诊治进展

子宫颈癌是女性常见恶性肿瘤之一，发病率位于所有女性恶性肿瘤的第4位。宫颈癌的发生与高危型人乳头瘤病毒（HPV）感染密切相关。子宫颈鳞状上皮内病变是指由HPV感染导致的一种病理改变，可能进展为宫颈癌前病变甚至癌。准确筛查宫颈上皮内病变并个体化制定诊疗方案对预防宫颈癌的发生和发展具有重要意义。本文就子宫颈高级别鳞状上皮内病变的诊治进展作一简要概述。     

Recurrent Rates with Cervical Intraepithelial Neoplasia having a Negative Surgical Margin after the Loop Electrosurgical Excision Procedure in Thailand

LEEP conization has become the treatment of choice in patients presenting with high grade intraepitheliallesions (HSILs) especially in cases with negative surgical margins. However, surveillance after such treatmentis necessary due to the potential for recurrence. To evaluate the recurrent rate in patients with negative surgicalmargins after HSIL treatment with LEEP, the medical records of such patients treated between January 2000and June 2007 were reviewed. All of them subsequently underwent Pap smears every 4-6 months to detect therecurrence of cervical intraepithelial neoplasia. There were 272 patients in the study period. Of these, 9 (3.3%)developed abnormal Pap smears with a median follow up of 12 months. The abnormal smears featured: atypicalsquamous cells of undetermined significance in 5 cases; atypical squamous cells where high grade squamouscell intraepithelial lesion cannot be excluded in 2 cases; and low grade squamous intraepithelial lesions in the 2remaining cases. Further investigation with colposcopic directed biopsies were conducted in all who exhibitedan abnormal Pap smear and only 3 of them (1.1%) showed cervical dysplasia at biopsy. In conclusion, thepatients with HSIL who were treated with LEEP and have negative surgical margins have a very low recurrencerate.