A Follow-up Study of Atypical Squamous Cells in Gynecologic Cytology Using Conventional Papanicolaou Smears and Liquid-Based Preparations

Abstract

We evaluated the impact of the Bethesda System (TBS) 2001 in cytology reporting of atypical squamous cells (ASC) when using conventional Pap smears and liquid-based cytology preparations (LBC). Follow-up information for all ASC cases encountered in Queen Mary Hospital, Hong Kong, China, from July 2000 to June 2004 (using TBS 1991 in the first 2-year period and TBS 2001 in the second) was analyzed. Among 4, 089 ASC cases studied, more than 50% had negative follow-up; this percentage was lower with TBS 2001. The percentage of ASC cases with a low-grade cervical intraepithelial neoplasia (CIN) end point was higher with TBS 2001, especially after application of LBC. There was also a decreasing trend of having this low-grade CIN end point with advancing age. Most clinically significant outcomes occurred after 6 months and before 1 year post-ASC diagnosis. With TBS 2001, more than 50% of ASC, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) were associated with high-grade CIN on follow-up. TBS 2001 improves the positive predictive value of ASC for clinically significant lesions. Introduction of dichotomous subcategorization of ASC is relevant, with ASC-H associated with a much higher risk of subsequent high-grade squamous lesions.

Reflex High Risk HPV Testing in Atypical Squamous Cells, Cannot Exclude High Grade Intraepithelial Lesion: A Large Institution’s Experience with the Significance of This Often Ordered Test

“…In our institution the ASC-H incidence was 0.2%, which falls into the lower range when compared to the literature [16,17,18,19,20,21,22,23,24,25,26,27,28]. The reported rate of subsequent surgical biopsy of high grade cervical intraepithelial neoplasia (CIN 2/3) after ASC-H ranges from 12.2 to 68.2% [3,4,22,25,29,30].…”

“…ASC-H is a much less common interpretation rendered on Pap smears and the reported incidence ranges from 0.22 to 1.09% of all Pap results [9,10,11,12,13,14,16,17,18,19,20,21,22,23,24,25,26,27,28]. In our institution the ASC-H incidence was 0.2%, which falls into the lower range when compared to the literature [16,17,18,19,20,21,22,23,24,25,26,27,28].…”

Practical usefulness of atypical endometrial cell categories within the new classification of endometrial cytology when applied to conventional smears

“…In TBS, 'ASC-US (atypical squamous cells, of undetermined significance)' is defined as 'cellular abnormalities that were more marked than those attributable to reactive changes but that quantitatively or qualitatively fell short of a definitive diagnosis of 'squamous intraepithelial lesion' (SIL). 5 Another category, 'ASC-H (atypical squamous cells, cannot exclude HSIL)' is more closely related to cervical intraepithelial neoplasia (CIN2-3) than ASC-US, 8,[13][14][15][16][17] and reflects a mixture of true HSIL and its mimics. 5 In endometrial cytology, the ATEC-US category describes samples containing atypical cells that cannot be definitively described as endometrial hyperplasia and could include cellular changes caused by inflammation, metaplasia or iatrogenic events, among others.…”

The cytology and DNA detection by the PapilloCheck® test in the diagnosis of human papillomavirus infection

“…More than 8% showed ASC-US, and 0.14% had ASC-H. These two categories correspond to an inexact diagnosis, because, although it seems to be cytological changes suggestive of squamous intraepithelial lesion, these are qualitatively or quantitatively insuffi cient to make sure that in fact this is the correct diagnosis [29,30]. However, the fact that this classifi cation is not associated with the presence of HPV does not mean that it can be ignored.…”