Abstract
Objective : To investigate how the diagnosis of ASC-H has changed over time after the introduction of TBS at four general hospitals with different patient backgrounds and medical care systems.
Study Design : Patients visit Hospital A mainly for medical check-up, while subjects visit Hospital B, Hospital C and Hospital D mainly for medical treatment. We investigated the four following issues during the first and third years after the introduction of TBS at these hospitals ; 1) the number of specimens and sample devices ; 2) the percentage of ASC-H as compared to ASC ; 3) evidence supporting the diagnosis of ASC-H ; 4) histopathology of ASC-H.
Results : Hospitals mainly used swabs in the first year, while they changed to using mainly brushes in the third year. The percentages of ASC-H at the three institutions in the first year were as follows ; Hospital A : 13% ; Hospital B : 33% ; Hospital C : 30% ; Hospital D : 22%. In the third year, the percentages changed to ; Hospital A : 9% ; Hospital B : 38% ; Hospital C : 37% ; Hospital D : 25%. The patients were diagnosed with ASC-H based on an indistinct nuclear composition in piled atypical cell clusters, atypical cells less than HSIL, and the difficulty in sorting in those who had received cancer treatment. The biopsy enforcement rates in the first year were ; Hospital A : 73% ; Hospital B : 74% ; Hospital C : 95% ; Hospital D : 63%. The rates in the third year were ; Hospital A : 100% ; Hospital B : 68% ; Hospital C : 88% ; Hospital D : 33%. The percent diagnosis of CIS had increased.
Conclusion : The percentage of ASC-H exceeded the target rate of 10% in those institutions that mainly engaged in medical treatment. It is a great challenge to understand how we should observe the piled clusters that are ascribed to brush collection. It is necessary to reconsider the problems regarding atypical cells in those who received have cancer treatment and how to handle the analysis of ASC-H.
