Abstract
Objective
Despite the usefulness of Pap tests for cancer screening, outcomes can be difficult
to predict when atypical squamous cells (ASCs) are identified. According to the 2001
Bethesda system, ASCs can be subdivided into two groups: ASCs of undetermined significance
(ASC-US); and ASCs, cannot exclude high-grade squamous intra-epithelial lesion (ASC-H).
ASC-H interpretations are uncommon, and studies involving this type of lesion are
based on small numbers of cases.
Study design
Cross-sectional, retrospective study of 392 ASC-H cases. The follow-up outcomes of
ASC-H cases that were diagnosed during routine primary screening between 2002 and
2008 were investigated, and relationships between clinicopathological parameters were
assessed, particularly positive test for high-risk HPV (HPV) DNA, patient age at diagnosis
and previous abnormal cytology.
Results
Of the 392 cases, high-grade squamous intra-epithelial lesion (HSIL) was detected
in 111 (28.3%) cases, squamous cell carcinoma was detected in 15 (3.8%) cases, low-grade
squamous intra-epithelial lesion was detected in 37 (9.4%) cases, reactive change
was detected in 178 (45.4%) cases, atrophy was detected in 47 (12.0%) cases, and adenocarcinoma
was detected in four (1.0%) cases. The prevalence of HSIL or greater was 27.8% for
women aged ≥40 years, and 52.3% for women aged <40 years (p < 0.001). HPV positivity in ASC-H smears was significantly associated with HSIL or greater,
irrespective of age (<40 years, p = 0.003; ≥40 years, p < 0.001). ASC-H with previous abnormal cytology greater than ASC-US showed a significantly
higher detection rate for HSIL or greater at follow-up (p < 0.001).
Conclusions
Patient age, positive HPV DNA test and previous abnormal cytology are useful predictors
of underlying HSIL or greater in women with ASC-H.
Keywords
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References
- Cervical cancer.Lancet. 2003; 361: 2217-2225
- Trends in incidence and mortality rates of squamous cell carcinoma and adenocarcinoma of cervix – worldwide.Asian Pac J Cancer Prev. 2009; 10: 645-650
- ASC-H in Pap test – definitive categorization of cytomorphological spectrum.Cytojournal. 2006; 10: 14
- 2001 Consensus guidelines for the management of women with cervical cytological abnormalities.JAMA. 2002; 287: 2120-2129
- Prevalence of cervical intraepithelial neoplasia grades II/III and cervical cancer in patients with cytological diagnosis of atypical squamous cells when high-grade intraepithelial lesions (ASC-H) cannot be ruled out.Sao Paulo Med J. 2009; 127: 283-287
- Atypical squamous metaplastic cells: reproducibility, outcome, and diagnostic features on ThinPrep Pap test.Cancer. 2001; 93: 16-22
- Reporting of atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion (ASC-H) on cervical samples: is it significant?.Diagn Cytopathol. 2003; 29: 38-41
- Atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion: the practice experience of a hospital-based reference laboratory with this new Bethesda system diagnostic category.Diagn Cytopathol. 2005; 32: 243-246
- Underlying pathology of women with “atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion” smears, in a region with a high incidence of cervical cancer.J Obstet Gynaecol Res. 2008; 34: 204-209
- Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion. A follow-up study of conventional and liquid-based preparations in a high-risk population.Am J Clin Pathol. 2003; 120: 392-397
- The 2001 Bethesda system: terminology for reporting results of cervical cytology.JAMA. 2002; 287: 2114-2119
- The analysis and clinical usefulness of HPV DNA Chip test in the uterine cervix.Korean J Pathol. 2010; 44: 77-82
- Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion: cytohistologic correlation study with diagnostic pitfalls.Acta Cytol. 2008; 52: 169-177
- Clinical significance of cytologic diagnosis of atypical squamous cells, cannot exclude high grade, in perimenopausal and postmenopausal women.Am J Clin Pathol. 2006; 126: 381-388
- Qualification of ASCUS. A comparison of equivocal LSIL and equivocal HSIL cervical cytology in the ASCUS LSIL Triage Study.Am J Clin Pathol. 2001; 116: 386-394
- Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion: diagnostic performance, human papillomavirus testing, and follow-up results.Cancer. 2006; 108: 32-38
- “ASCUS, rule out HSIL”: cytologic features, histologic correlates, and human papillomavirus detection.Mod Pathol. 1999; 12: 335-342
- The use of p16(INK4A) immunocytochemistry in “atypical squamous cells which cannot exclude HSIL” compared with “atypical squamous cells of undetermined significance” in liquid-based cervical smears.Diagn Cytopathol. 2010; 38: 168-171
- Age-specific evaluation of primary human papillomavirus screening vs conventional cytology in a randomized setting.J Natl Cancer Inst. 2009; 101: 1612-1623
- The significance of “low-grade squamous intraepithelial lesion, cannot exclude high-grade squamous intraepithelial lesion” as a distinct squamous abnormality category in Papanicolaou tests.Cancer. 2006; 108: 277-281
- Reporting of “LSIL with ASC-H” on cervicovaginal smears: is it a valid category to predict cases with HSIL follow-up?.Eur J Gynaecol Oncol. 2004; 25: 462-464
- The significance of the Papanicolaou smear diagnosis of low-grade squamous intraepithelial lesion cannot exclude high-grade squamous intraepithelial lesion.Cancer. 2003; 99: 272-276
- Should LSIL with ASC-H (LSIL-H) in cervical smears be an independent category? A study on SurePath specimens with review of literature.Cytojournal. 2007; 4: 7
Article info
Publication history
Published online: June 03, 2011
Accepted:
May 19,
2011
Received in revised form:
October 23,
2010
Received:
June 28,
2010
Identification
Copyright
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
