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Salibay C, Chen Z, Ma B, Pan H, Hijazi M, Elatre W, Shulman I, Martin SE, Wang T. High-risk HPV testing improves accuracy in detection of CIN2+ lesions in ASC-H postmenopausal women? An academic hospital experiences. J Am Soc Cytopathol 2023; 12:58-65. [PMID: 36270913 DOI: 10.1016/j.jasc.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/29/2022] [Accepted: 08/27/2022] [Indexed: 11/18/2022]
Abstract
Reflex human papilloma virus (HPV) testing with "atypical squamous cells, cannot exclude high-grade squamous lesion (ASC-H)" cytologic diagnosis is not recommended by American Society for Colposcopy and Cervical Pathology guidelines. Studies have shown human papillomavirus (HPV)-negative ASC-H patients of increased age are low risk for cervical intraepithelial neoplasia 2 or worse (CIN2+) lesions on colposcopic follow-up. We retrospectively assessed the efficacy of reflex HPV testing in postmenopausal women with ASC-H in the Los Angeles County hospitals and clinics in a 5-year period. Of a total 85 clinically postmenopausal women with ASC-H, 31 (36.5%) women were found to have CIN2+ lesions on follow-up biopsy and five of them were HPV-negative. Of the women with CIN2+ lesions and positive HPV, 13 (41.9%) were high-risk HPV (hrHPV) 16/18/45 positive and 13 (41.9%) were hrHPV-other subtype positive. Women with positive HPV had an over 3-fold increased risk of developing CIN2+ lesions (P = 0.008). Relative risk of hrHPV16/18/45 was 1.79-fold higher than that of hrHPV-other subtype. The positive predictive value and negative predictive value of hrHPV were 49.1% and 84.4%, respectively. CIN2+ detection rate in Hispanic women with positive hrHPV was higher than in non-Hispanic women (53.8% versus 35.7%). Overall, postmenopausal women with ASC-H cytology result and negative hrHPV were less likely to develop CIN2+ lesions, whereas about half of ASC-H postmenopausal women develop CIN2+ lesions if hrHPV positive, especially if hrHPV 16/18/45 positive. Therefore, triaging ASC-H postmenopausal women with cotesting or, ideally, hrHPV genotyping should be considered as optimal clinical practice to avoid overtreatment.
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Affiliation(s)
- Christine Salibay
- Department of Pathology and Laboratory Medicine, University of Southern California/LAC-USC Medical Center, Los Angeles, California; Kaiser Permanente, South Bay Medical Center Pathology Department. Harbor City, California
| | - Zhengshan Chen
- Department of Pathology and Laboratory Medicine, University of Southern California/LAC-USC Medical Center, Los Angeles, California; Department of Pathology and Laboratory Medicine, University of California, Los Angeles, California
| | - Brian Ma
- Department of Pathology and Laboratory Medicine, University of Southern California/LAC-USC Medical Center, Los Angeles, California
| | - Hui Pan
- Department of Pathology and Laboratory Medicine, University of Southern California/LAC-USC Medical Center, Los Angeles, California
| | - Maya Hijazi
- Department of Pathology and Laboratory Medicine, University of Southern California/LAC-USC Medical Center, Los Angeles, California
| | - Wafaa Elatre
- Department of Pathology and Laboratory Medicine, University of Southern California/LAC-USC Medical Center, Los Angeles, California
| | - Ira Shulman
- Department of Pathology and Laboratory Medicine, University of Southern California/LAC-USC Medical Center, Los Angeles, California
| | - Sue E Martin
- Department of Pathology and Laboratory Medicine, University of Southern California/LAC-USC Medical Center, Los Angeles, California
| | - Tiannan Wang
- Department of Pathology and Laboratory Medicine, University of Southern California/LAC-USC Medical Center, Los Angeles, California.
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Ratree S, Kleebkaow P, Aue-Aungkul A, Temtanakitpaisan A, Chumworathayi B, Luanratanakorn S. Histopathology of Women with “Atypical Squamous Cells Cannot Exclude High-Grade Squamous Intraepithelial Lesion”
(ASC-H) Smears. Asian Pac J Cancer Prev 2019; 20:683-686. [PMID: 30909664 PMCID: PMC6825754 DOI: 10.31557/apjcp.2019.20.3.683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives: To evaluate prevalence of underlying significant pathologies among women with cervical smears
rated as ‘atypical squamous cells cannot exclude high grade squamous intraepithelial lesion (ASC-H)’, as well as
associated risk factors. Methods: Medical records were reviewed of all consecutive women with ASC-H smears who
had undergone colposcopy at Srinagarind Hospital from January 2008 to July 2016. Significant pathology results
included cervical intraepithelial neoplasia (CIN) 2-3, adenocarcinoma in situ (AIS), endometrial hyperplasia, and
cancer of any original site. Result: During the study period, 133 women with ASC-H were reviewed. The mean age
was 45.3 years (range 21-72). The histopathologic results for the 133 women were as follows: no lesions (58; 43.6%),
CIN 1 (34; 25.6%), CIN 2-3 (33; 24.8%), AIS (2; 1.5%), and cervical cancer (6; 4.5%). The overall rate of significant
pathology was 30.8% (95% confidence interval, 22.9%-38.8%). Women younger than 40 years old carried a higher
risk of harboring significant lesions when compared to older women (41.7% versus 27.8%, respectively). There was
no significant impact of parity and menopausal status on the risk of significant pathology results. Conclusion: The
rate of significant histopathologies among women with ASC-H smears in this study was approximately 31% and the
associated risk factor was patient age.
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Affiliation(s)
- Sasivimon Ratree
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Pilaiwan Kleebkaow
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Apiwat Aue-Aungkul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Amornrat Temtanakitpaisan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Bandit Chumworathayi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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Díaz Del Arco C, Sanabria Montoro MC, García López D, Rodríguez Escudero E, Fernández Aceñero MJ. Clinical Relevance of ASC-H Cytologies: Experience in a Single Tertiary Hospital. Acta Cytol 2016; 60:217-24. [PMID: 27490700 DOI: 10.1159/000448022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 06/27/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To review the cases of atypical squamous cells (ASC), cannot exclude squamous intraepithelial lesion (ASC-H) diagnosed at a single institution and to discuss the interpretation challenges and clinical management of these cases. STUDY DESIGN The ASC-H cases diagnosed at our institution from 2006 to 2015 were studied retrospectively; of 159,000 Pap smears, there were 959 cases of ASC of undetermined significance (ASC-US) and 148 cases of ASC-H. We have reviewed the clinical records of the ASC-H cases, and data have been analyzed using SPSS 20.0. RESULTS Median age was 43.1 years; 49.6% of the patients had previous cervical cytologies, and 55.9% of them were negative. Following ASC-H diagnosis, another smear was obtained in 97.1% of the cases and in 67.6% a biopsy was performed. Biopsy revealed low-grade dysplasia in 18.8% of the cases, high-grade dysplasia in 27.8%, and infiltrating carcinoma in 2.3%. Patients with significant lesions in histology were younger than patients with negative results (p = 0.08). A diagnosis of ASC-H/squamous intraepithelial lesion in the repeated cytology had a sensitivity of 74.2%, specificity of 39.6%, positive predictive value of 44.8%, and negative predictive value of 70% for the diagnosis of dysplasia. CONCLUSIONS ASC-H diagnosis is associated with a high incidence of histological high-grade lesions. A repeat cytology can aid in the selection of high-risk patients, but there may be false-negative results.
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Kingnate C, Supoken A, Kleebkaow P, Chumworathayi B, Luanratanakorn S, Kietpeerakool C. Is Age an Independent Predictor of High-Grade Histopathology in Women Referred for Colposcopy after Abnormal Cervical Cytology? Asian Pac J Cancer Prev 2015; 16:7231-5. [PMID: 26514516 DOI: 10.7314/apjcp.2015.16.16.7231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This study was conducted to determine whether advancing age is an independent predictor of increased risk of high-grade pathologies among women referred for colposcopy after abnormal cervical cytology. Medical records were reviewed for women with abnormal cervical cytology who underwent colposcopy at Khon Kaen University Hospital. Logistic regression was used to determine the independent impact of age on the risk of high-grade pathologies. Mean age of the women was 42.8 years. Of 482 women, 97 (20.1%) were postmenopausal, and 92 (19.1%) were nulliparous. The rate of high-grade pathologies included cervical intraepithelial neoplasia 2-3, 99 (20.5%), adenocarcinoma in situ, 4 (0.8%), cervical cancer, 30 (6.2%), and endometrial cancer, 1 (0.2%). The prevalence of significant lesions was 26.9% (95% CI, 23.1%-31.2%). In total, 31 women had cancers (6.4%; 95% CI, 4.4%-9.0%). When controlling for smear types and parity, age was noted to be a significant independent predictor of high-grade histopathology. Women older than 35-40 years were approximately 2 times as likely to have severe histopathology as the younger women. This study illustrates the substantial risk of underlying significant lesions especially invasive cancer in Thai women with abnormal cervical cytology. Age was a significant independent factor predicting the risk of high-grade pathologies.
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Affiliation(s)
- Chalita Kingnate
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand E-mail :
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Factors affecting compliance in the first year of postcolposcopy surveillance among women with a high incidence of cervical cancer. Int J Gynaecol Obstet 2013; 124:160-3. [DOI: 10.1016/j.ijgo.2013.07.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/18/2013] [Accepted: 10/02/2013] [Indexed: 11/22/2022]
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Cervical cytology with a diagnosis of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H): a follow-up study with corresponding histology and significance of predicting dysplasia by human papillomavirus (HPV) DNA testing. Arch Gynecol Obstet 2013; 289:645-8. [DOI: 10.1007/s00404-013-3015-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
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Pothisuwan M, Pataradool K, Tangjitgamol S, Srijaipracharoen S, Manusirivithaya S, Thawaramorn T. Visual inspection with acetic acid for detection of high grade lesion in atypical squamous cells and low grade squamous intraepithelial lesions from cervical Pap smear. J Gynecol Oncol 2011; 22:145-51. [PMID: 21998756 PMCID: PMC3188712 DOI: 10.3802/jgo.2011.22.3.145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 04/26/2011] [Accepted: 05/13/2011] [Indexed: 11/08/2022] Open
Abstract
Objective To evaluate the value of visual inspection with acetic acid (VIA) test to detect high grade lesion in women with atypical squamous cells or low grade squamous intraepithelial lesions cervical cytology. Methods Women with atypical squamous cells or low grade squamous intraepithelial lesions who were scheduled to undergo colposcopy at Vajira Hospital and met inclusion criteria were included. All participants underwent VIA test prior to usual steps of colposcopy. The VIA results were interpreted as positive or negative using the criteria by the International Agency for Cancer Research. The standard colposcopic examination and appropriate investigations for cervical pathology were then continued. The diagnostic values of VIA test including sensitivity, specificity, positive predictive value, and negative predictive value were determined using high grade lesion including cervical intraepithelial neoplasia 2-3 and squamous cell carcinoma as a threshold. Results Total of 106 women was included. The VIA test was positive in 33 women (31.1%) and negative in 73 women (68.9%). Among the women with VIA test positive, 14 had high grade lesion (42.4%) while 19 had no significant lesions. Only 2/73 (2.7%) cases with negative VIA test had high grade lesion (both had cervical intraepithelial neoplasia 2). The sensitivity, specificity, positive predictive value and negative predictive value with 95% confidence interval were 87.5% (81.2 to 93.8%), 78.8% (71.1 to 86.7%), 42.4% (33.0 to 51.8%), and 97.2% (94.2 to 1.0%) respectively. Conclusion VIA as the intermediate test in atypical squamous cells and low grade squamous intraepithelial lesions cytology may reduce the necessity to refer some women for colposcopy.
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Affiliation(s)
- Methasinee Pothisuwan
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Vajira Hospital, University of Bangkok Metropolitan Administration Medical College, Bangkok, Thailand
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Atypical squamous cells of undetermined significance: Bethesda classification and association with Human Papillomavirus. Infect Dis Obstet Gynecol 2011; 2011:904674. [PMID: 21760701 PMCID: PMC3132509 DOI: 10.1155/2011/904674] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 03/31/2011] [Indexed: 12/03/2022] Open
Abstract
Introduction. To analyze patients with atypical squamous cells of undetermined significance (ASCUS) through a cytology review and the presence of microbiological agents, with consideration of colposcopy and semiannual tracking. Methods. 103 women with ASCUS were reviewed and reclassified: normal/inflammatory, ASCUS, low-grade squamous intraepithelial lesion (LSIL), or high-grade squamous intraepithelial lesion (HSIL). If ASCUS confirmed, it was subclassified in reactive or neoplastic ASCUS, ASC-US, or ASC-H; and Regione Emilia Romagna Screening Protocol. Patients underwent a colposcopic examination, and test for Candida sp., bacterial vaginosis, Trichomonas vaginalis, and human papillomavirus (HPV) were performed. Results. Upon review, ASCUS was diagnosis in 70/103 (67.9%), being 38 (54.2%) reactive ASCUS and 32 (45.71%) neoplastic ASCUS; 62 (88.5%) ASC-US and 8 (11.41%) ASC-H. ASCUS (Regione Protocol), respectively 1-5: 15 (21.4%), 19 (27.1%), 3 (27.1%), 16 (22.8%), and 1 (1.4%). A higher number of cases of cervical intraepithelial neoplasia (CIN) II/III in the biopsies of patients with ASC-H compared to ASC-US (P = .0021). High-risk HPV test and presence of CIN II/III are more frequent in ASC-H than ASC-US (P = .031). Conclusions. ASC-H is associated with clinically significant disease. High-risk HPV-positive status in the triage for colposcopy of patients with ASC-US is associated with increased of CIN.
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Sung CO, Oh YL, Song SY. Cervical cytology of atypical squamous cells, cannot exclude high-grade squamous intra-epithelial lesion: significance of age, human papillomavirus DNA detection and previous abnormal cytology on follow-up outcomes. Eur J Obstet Gynecol Reprod Biol 2011; 159:155-9. [PMID: 21683502 DOI: 10.1016/j.ejogrb.2011.05.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 10/23/2010] [Accepted: 05/19/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Despite the usefulness of Pap tests for cancer screening, outcomes can be difficult to predict when atypical squamous cells (ASCs) are identified. According to the 2001 Bethesda system, ASCs can be subdivided into two groups: ASCs of undetermined significance (ASC-US); and ASCs, cannot exclude high-grade squamous intra-epithelial lesion (ASC-H). ASC-H interpretations are uncommon, and studies involving this type of lesion are based on small numbers of cases. STUDY DESIGN Cross-sectional, retrospective study of 392 ASC-H cases. The follow-up outcomes of ASC-H cases that were diagnosed during routine primary screening between 2002 and 2008 were investigated, and relationships between clinicopathological parameters were assessed, particularly positive test for high-risk HPV (HPV) DNA, patient age at diagnosis and previous abnormal cytology. RESULTS Of the 392 cases, high-grade squamous intra-epithelial lesion (HSIL) was detected in 111 (28.3%) cases, squamous cell carcinoma was detected in 15 (3.8%) cases, low-grade squamous intra-epithelial lesion was detected in 37 (9.4%) cases, reactive change was detected in 178 (45.4%) cases, atrophy was detected in 47 (12.0%) cases, and adenocarcinoma was detected in four (1.0%) cases. The prevalence of HSIL or greater was 27.8% for women aged ≥ 40 years, and 52.3% for women aged <40 years (p<0.001). HPV positivity in ASC-H smears was significantly associated with HSIL or greater, irrespective of age (<40 years, p=0.003; ≥ 40 years, p<0.001). ASC-H with previous abnormal cytology greater than ASC-US showed a significantly higher detection rate for HSIL or greater at follow-up (p<0.001). CONCLUSIONS Patient age, positive HPV DNA test and previous abnormal cytology are useful predictors of underlying HSIL or greater in women with ASC-H.
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Affiliation(s)
- Chang Ohk Sung
- Department of Pathology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea
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Sawangsang P, Sae-Teng C, Suprasert P, Srisomboon J, Khunamornpong S, Kietpeerakool C. Clinical significance of atypical glandular cells on Pap smears: Experience from a region with a high incidence of cervical cancer. J Obstet Gynaecol Res 2010; 37:496-500. [DOI: 10.1111/j.1447-0756.2010.01387.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Treatment of high-grade squamous intraepithelial lesions in an area of Thailand with a high incidence of cervical cancer. Int J Gynaecol Obstet 2010; 111:253-5. [PMID: 20817178 DOI: 10.1016/j.ijgo.2010.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 07/06/2010] [Accepted: 08/06/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To audit the treatment of high-grade squamous intraepithelial lesions (HSILs) at Chiang Mai University Hospital based on 12 standard requirements of the National Health Service Cervical Screening Programme. METHODS Records were reviewed of all women with histologically proven HSIL undergoing treatment at Chiang Mai University Hospital between January 2005 and May 2009. RESULTS Four of the standard requirements were not met: not all women underwent colposcopy before definitive treatment; the rate of specimen fragmentation was high; among women with ectocervical lesions, the rate of tissue removal to a depth of greater than 7 mm was low; and among women aged over 50 years with endocervical-margin involvement, the rate of repeat excision was low. CONCLUSION This audit highlights four treatment practices that do not meet standard requirements and require detailed exploration. The development of guidelines for the treatment of cervical precancerous lesions in Thailand is challenging and merits further attention.
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Kietpeerakool C, Manopunya M, Phuprasertsak P, Jaijit T, Srisomboon J. An audit of colposcopy appointment processes in women with abnormal cervical cytology. Cytopathology 2010; 22:184-8. [DOI: 10.1111/j.1365-2303.2010.00790.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Preceding cervical cytology in women with high-grade squamous intraepithelial lesion. Arch Gynecol Obstet 2010; 283:1381-4. [PMID: 20607262 DOI: 10.1007/s00404-010-1581-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 06/24/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the preceding cervical cytology and factors leading to cytohistologic discrepancy in women with high-grade squamous intraepithelial lesion (HSIL) histology. METHODS The records of women who were found to have histologically confirmed HSIL without any associated invasive and glandular lesions, at Chiang Mai University Hospital between January 2005 and May 2009, were reviewed. Cytohistological discrepancy was defined as HSIL histology preceded by low-grade squamous intraepithelial lesion (LSIL) and atypical squamous cells of undetermined significance (ASC-US) smears. RESULTS The records of 436 HSIL cases were reviewed. The mean age of the women was 45.0 ± 9.3 years. The preceding smear abnormalities were as follows: 275 (63.1%) with HSIL; 50 (11.5%) with atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H); 40 (9.2%) with squamous cell carcinoma; 35 (8.0%) with LSIL; 32 (7.3%) with ASC-US; and 4 (0.9) with glandular abnormality smears. Overall, the rate of cytohistological discrepancy was 15.4% (95% CI 12.1-19.1%). The small size of HSIL and presence of coexisting LSIL are significant independent predictors for cytohistologic discrepancy. CONCLUSION Approximately 15% of HSIL cases are under-diagnosed by cytology. Significant factors leading to cytohistologic discrepancy are lesion size and the presence of coexisting LSIL.
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Manopunya M, Suprasert P, Srisomboon J, Kietpeerakool C. Colposcopy audit for improving quality of service in areas with a high incidence of cervical cancer. Int J Gynaecol Obstet 2010; 108:4-6. [PMID: 19892342 DOI: 10.1016/j.ijgo.2009.07.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 07/25/2009] [Accepted: 09/14/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To audit routine colposcopy performance using 8 standard requirements of the National Health Service Cervical Screening Programme (NHSCSP). METHODS Records of women who underwent colposcopy for abnormal cervical cytology between January and December 2008 at Chiang Mai University Hospital, Thailand, were reviewed. RESULTS The standard requirements were not achieved in 2 practices: (1) the proportion of women who had recordings of visibility of the transformation zone (96.6%) did not achieve the NHSCSP requirement of 100%; and (2) the rate of excisional biopsy (87.8%) was lower than the 95% minimum required. CONCLUSION Colposcopic performance at Chiang Mai University Hospital was generally favorable. However, re-audit is necessary to ensure that unmet standards of performance are improved and achieved standards are maintained.
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Affiliation(s)
- Manatsawee Manopunya
- Department of Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand
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Kietpeerakool C, Cheewakriangkrai C, Suprasert P, Srisomboon J. Feasibility of the ‘see and treat’ approach in management of women with ‘atypical squamous cell, cannot exclude high-grade squamous intraepithelial lesion’ smears. J Obstet Gynaecol Res 2009; 35:507-13. [DOI: 10.1111/j.1447-0756.2008.00992.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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