Present status of cervical cancer screening based on The Bethesda System (TBS) in Osaka Prefecture with special reference to guideline management of ASC-US and detection of high-risk HPV-DNA

Abstract

Objective : We evaluated cervical cancer screening status based on The Bethesda System (TBS) in Osaka, focusing on atypical squamous cells of undetermined significance (ASC-US) and human papilloma virus (HPV).
Study Design : We studied TBS-based cervical cancer screening status in 18 Osaka Prefecture cities and towns. Subjects numbering 1,176 subjects were seen at Osaka Cancer Prevention and Detection Center colposcopy clinics for cytology, colposcopy, histology, and high-risk HPV-DNA testing using hybrid capture (HC)-2.
Results : TBS and HPV-DNA knowledge is now relatively widespread, but not TBS knowledge on the need for repeated cell sampling for inadequate specimens, clinical ASC-US management, or cytological high-grade cervical squamous intraepithelial lesion (HSIL) classification. The positive high-risk HPV-DNA rate among our 1,176 cases was 38%. Cervical intraepithelial neoplasia (CIN) 1 or 2 was detected in 11 of 15 (83%) positive for high-risk HPV-DNA with ASC-US. The persistence or disappearance of CIN lesions in ASC-US was closely associated with high-risk HPV-DNA status.
Conclusion : The clinical importance of TBS and ASC-US must be disseminated more widely among subjects in Osaka Prefecture. High-risk HPV-DNA testing appears to be quite useful in managing cases involving ASC-US.