Atypical squamous cells and low squamous intraepithelial lesions in postmenopausal women: Implications for management

Abstract Objectives To determine whether the use of local Estrogen Replacement Therapy (ERT) affects the adequacy of colposcopic examination; to distinguish abnormal cervical smears secondary to hypoestrogenism from abnormal cervical smears due to true preneoplastic changes; and to suggest an effect...

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Published in:European journal of obstetrics & gynecology and reproductive biology 2008-10, Vol.140 (2), p.269-274
Main Authors: Piccoli, Roberto, Mandato, Vincenzo D, Lavitola, Giada, Acunzo, Giuseppe, Bifulco, Giuseppe, Tommaselli, Giovanni A, Attianese, Wanda, Nappi, Carmine
Format: Article
Language:English
Subjects:
Administration, Intravaginal
ASCUS
Atrophy - diagnosis
Biological and medical sciences
Cervical Intraepithelial Neoplasia - diagnosis
Colposcopy - standards
Diagnosis, Differential
ERT
Estradiol - administration & dosage
Estradiol - analogs & derivatives
Estrogen Replacement Therapy
Female
Female genital diseases
Gynecology. Andrology. Obstetrics
Humans
LSIL
Medical sciences
Menopause
Middle Aged
Obstetrics and Gynecology
Papanicolaou Test
Tumors
Uterine Cervical Dysplasia - diagnosis
Uterine Cervical Neoplasms - diagnosis
Vagina - pathology
Vaginal Diseases - diagnosis
Vaginal Diseases - drug therapy
Vaginal Smears
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Summary:Abstract Objectives To determine whether the use of local Estrogen Replacement Therapy (ERT) affects the adequacy of colposcopic examination; to distinguish abnormal cervical smears secondary to hypoestrogenism from abnormal cervical smears due to true preneoplastic changes; and to suggest an effective management of atypical squamous cells of undeterminated significance (ASCUS) and low grade squamous intraepithelial lesion (L-SIL) in menopausal women. Study design Two-hundred fifty-four postmenopausal women with abnormal pap smears (L-SIL or ASCUS) underwent colposcopy and HPV DNA testing. All patients with positive colposcopy underwent punch biopsy, and all patients with positive histological findings underwent surgical treatment. Patients with negative colposcopy, both satisfactory [visible Squamo-Columnar Junction (SCJ)] and unsatisfactory, were treated with local estrogenic replacement therapy (ERT) for 3 months, and repeated colposcopy and pap smears. Patients with negative colposcopy and negative pap smears after ERT were included in a 6 months cytological and colposcopic follow-up. Patients with positive colposcopy underwent punch biopsy, if colposcopy was negative and cytology was positive, patients underwent endocervical curettage. Results One-hundred ninety-five had a diagnosis of ASCUS and 59 a diagnosis of L-SIL. At the first colposcopy, 39 patients showed a lesion and had an appropriate treatment. One-hundred eighty-eight in the ASCUS group and 27 in the L-SIL group had a negative colposcopy and were treated with local ERT. At first colposcopic examination, 37 of the 215 negative colposcopies resulted satisfactory and 178 of the 215 resulted unsatisfactory. After local ERT, 130 of the 178 patients had a satisfactory follow-up colposcopy. After ERT, 25 patients of 215 with initial abnormal CVS and negative colposcopy, required appropriate treatment. After ERT, 190 patients of 215 showed negative colposcopy and at cytologic follow-up showed 23 ASCUS and 167 normal CVS. Conclusions A correct diagnosis and an efficient treatment seem to be obtained with a short-time ERT followed by a short-time cytological and colposcopic follow-up. With a single course of local ERT it may be possible to distinguish between benign CVS mimicking atrophy and true preneoplastic changes. Estrogen therapy will often cause enough ectropion of the endocervical cells so that the entire SCJ can be visualized. Moreover, it may reduce the number of endocervical curettage or
ISSN:0301-2115
1872-7654
DOI:10.1016/j.ejogrb.2008.05.007