Cytologic atypia. Clinical significance and follow-up recommendations.

OBJECTIVE: To assess the evolution of cytologic atypia on cervical cytologic smears as an attempt to better understand the natural history of these lesions and to establish a follow-up protocol. STUDY DESIGN: The study group consisted of 76 patients with a diagnosis of cytologic atypia on cervical cytologic smears performed at the Gynecology Outpatient Clinic, Hospital del Mar, between December 1989 and June 1993. Patients with inflammatory atypia, a reparative process or findings consistent with human papillomavirus infection had been excluded. Follow-up smears were reviewed. Compliance with follow-up recommendations was also evaluated. RESULTS: Thirty-nine patients returned to the clinic for follow-up after a diagnosis of atypia (51.3%). Progression from atypia to dysplasia was found in 38.5% of patients with at least a follow-up smear. Changes consistent with intraepithelial neoplasia were found in 17 patients : low grade dysplasia was found in 10 patients (mild dysplasia in 8 and atypia in 2) and high grade dysplasia in 7 (moderate in 4 and severe in 3). This progression was most commonly found at the first follow-up visit and within the first year. CONCLUSION: Patients with cytologic atypia were at higher risk of developing dysplasia than those with reparative atypia. Our results support the theory of progression from atypia to dysplasia in a considerable percentage of patients. Follow-up compliance in our patient population was low. One should emphasize the importance of this diagnosis and encourage close cytologic follow-up, especially within the first year after the diagnosis of atypia.