Cubaka Ntamushigo Jeremie, Motshedisi Sebitloane Hannah
Department of Gynecology-Obstetrics, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.
Int J Gynaecol Obstet. 2025 Feb;168(2):428-435. doi: 10.1002/ijgo.15915. Epub 2024 Sep 13.
In the present study we reviewed the existing literature regarding management approaches for ASC-US and highlight their pros and cons. The ASC-US entity emerged from Bethesda classification 2001. We conducted this review using search words ASC-US triage, ASC-US management in young women, triage tests for ASC-US, and ASC-US outcome from the English literature. We included different cervical cancer policies (American, European and for WHO) and research articles published on ASC-US in young women from the year 2001. We searched in Google Scholar, PubMed, MEDLINE (NCBI) library, Embase (Elsevier), Wiley online library as well as Cochrane library. We defined young women as aged 30 years and below. We identified 52 articles which focused on management approaches of ASC-US, seven articles focused on young women aged <30 years. Five of these articles combined ASC-US with low-grade squamous intraepithelial lesions (ASC-US/LSIL) while only two addressed ASC-US as a standalone entity. The limited number of articles restricts the evidence base supporting the adoption of triage strategies. There is yet, no consensus in the literature regarding the management of ASC-US, more so in young women below the age of 30 years. Researchers, however, agree on a few aspects, which include the necessity for applying a conservative strategy for managing ASC-US in young women, avoiding direct referral for colposcopy at the initial detection of ASC-US, and avoiding the use of human papillomavirus (HPV) testing on young women (unless living with HIV). Newer techniques such as HPV E6/E7 messenger RNA (mRNA), and dual staining p16/ki-67, may serve as better triage to identify cases of HPV persistence and integration which may subsequently lead to preinvasive or invasive lesions.
在本研究中,我们回顾了关于非典型鳞状细胞意义不明确(ASC-US)管理方法的现有文献,并强调了它们的优缺点。ASC-US这一实体源自2001年的贝塞斯达分类。我们使用搜索词“ASC-US分流”“年轻女性的ASC-US管理”“ASC-US的分流检测”以及英文文献中的“ASC-US结果”进行了这项综述。我们纳入了不同的宫颈癌诊疗策略(美国、欧洲以及世界卫生组织的)以及2001年以来发表的关于年轻女性ASC-US的研究文章。我们在谷歌学术、PubMed、MEDLINE(美国国立医学图书馆)数据库、Embase(爱思唯尔)、威利在线图书馆以及考克兰图书馆进行了搜索。我们将年轻女性定义为30岁及以下。我们确定了52篇关注ASC-US管理方法的文章,7篇关注年龄小于30岁的年轻女性。其中5篇文章将ASC-US与低级别鳞状上皮内病变(ASC-US/LSIL)合并讨论,而只有2篇将ASC-US作为一个独立实体进行论述。文章数量有限限制了支持采用分流策略的证据基础。关于ASC-US的管理,文献中尚未达成共识,在30岁以下的年轻女性中更是如此。然而,研究人员在一些方面达成了共识,这包括对年轻女性ASC-US采用保守管理策略的必要性、在初次检测到ASC-US时避免直接转诊至阴道镜检查以及避免对年轻女性使用人乳头瘤病毒(HPV)检测(除非感染艾滋病毒)。诸如HPV E6/E7信使核糖核酸(mRNA)和双重染色p16/ki-67等新技术,可能作为更好的分流手段,以识别HPV持续感染和整合的病例,这些病例随后可能导致癌前病变或浸润性病变。