Prevalence of Abnormal Cervical Cytology According to The Bethesda System, at King Chulalongkorn Memorial Hospital

Abstract

Objective To define the prevalence of abnormal cervical cytology in The Bethesda System
Study All cytologic smears from October 1999 to June 2001 were reviewed and classified
with the context of The Bethesda Classification System. Medical records of all patients with a
diagnosis of ASCUS, AGUS, LSIL, HSIL, squamous cell carcinoma and adenocarcinoma were
reviewed for previous medical history, diagnostic study, histologic diagnosis and prior gynecologic disease. The most significant histologic diagnosis from all biopsy specimens submitted
was compared with the abnormal cervical smear diagnostic categories in preinvasive and early
stage cervical cancer.
Result The prevalence of abnormal cervical cytology in 61,701 smears was 0.85%, which
can be classified into ASCUS 20.92%(114 smears), AGUS 8.44%(46 smears), LSIL 20.00%(109
smears), HSIL 34.68%(189 smears), squamous cell carcinoma 12.29%(67 smears) and
adenocarcinoma 3.67%(20 smears). We reviewed 287patients medical records that were new
cases with abnormal cervical cytology. One hundred (34.84%) were lost to follow up, thirty-four
(11.85%) were repeated pap smear. Colposcopes with or without biopsy were performed in
153 cases (53.31%). Cytologic diagnosis of histologically diagnosed as HSIL (CIN II or CINIII)
and cancer of cervix was HSIL 60.00%, AGUS 15.38%, LSIL 13.85 % and ASCUS 10.77%,
respectively.
Conclusion The prevalence of abnormal cervical cytology in our study was low compare to
other study. We recommended that all women with HSIL cytology should undergo intensive
evaluation including colposcopy with or without endocervical currettage. The lost to follow up
rate in King Chulalongkorn Memorial Hospital was relatively high, therefore, the patient call
and recall system which is existed should be re-evaluated.