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

Abstract

We compared the histologic follow-up of 368 smears or slides with an interpretation of "atypical squamous cells, cannot rule out high-grade squamous intraepithelial lesion" (ASC-H) based on conventional and liquid-based preparations and age groups in a high-risk population. Patients with an ASC-H interpretation were 17 to 87 years old (mean, 36.8 years). The specimens were 52 liquid-based preparations and 316 conventional smears. For 218 cases (59.2%), including 28 liquid-based preparations (65%) and 190 conventional smears (58%), histologic follow-up was available. In 20 liquid-based preparations (71%) and 152 conventional smears (80.0%), cervical intraepithelial neoplasia (CIN) or higher was revealed on subsequent biopsy. Other results were as follows: liquid-based preparations, CIN1, 11 (55%); CIN2/3, 9 (45%); conventional smears, CIN1, 78 (51.3%); CIN2/3, 70 (46.1%); squamous cell carcinoma, 4 (2.6%). There was no statistically significant difference in the incidence of CIN or higher on subsequent biopsy after an interpretation of ASC-H based on preparation types. The incidences of CIN in patients 40 years old or older and patients younger than 40 years were 66% and 84%, respectively, a statistically significant difference. Because of the high incidence of clinically significant lesions noted on subsequent follow-up, patients with an interpretation of ASC-H should be observed closely and referred for colposcopic examination regardless of their age.

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

“…In the study by Selvaggi, 13 the prevalence found was 68%, with an age range from 19 to 34. On the other hand, the four cases of invasive carcinoma found by Louro et al 15 occurred in women older than 40 years of age. Duncan and Jacob 17 found a high prevalence of CIN II/III in postmenopausal women (46.2%), but their results were compromised by the small sample size and because the cases only had histological diagnoses.…”

“…This gives rise to higher prevalence than the reality of clinical practice, reaching values from 26% to 68%. [13][14][15]17,18 Another likely reason was that we included cases in which the diagnostic conclusion was reached during the follow-up, which lowers the prevalence of the disease. According to Sherman et al, 23 the imperfect sensitivity of colposcopy for detecting small or focal pre-invasive lesions reinforces the need for strict follow-up among individuals with ASC-H cytology without lesions visible from colposcopy.…”

“…6,7,11,12 Cross-sectional studies evaluating the prevalence of CIN II and III among individuals with ASC-H cytology have found values between 26 and 68%. [13][14][15][16][17][18][19] There is some evidence that this prevalence is lower after the menopause. 15,17,20,21 …”

“…[13][14][15][16][17][18][19] There is some evidence that this prevalence is lower after the menopause. 15,17,20,21 …”

HPV testing results and histologic follow-up in women with ASC-H cytology in different age groups

“…2 Numerous studies have examined clinical significance and histological follow-up of ASC-H patients. [4][5][6][7][8][9][10] The ALTS (Atypical Squamous cells of Undetermined Significance/Low Grade Squamous Intraepithelial Lesion Triage) study has shown that age is an important factor in disease outcome and application of reflex HR-HPV DNA testing for ASC-US cytology. 5 However, assessment of the impact of age distribution on disease outcome and on HR-HPV status of ASC-H is limited due to the small number of cases in the previously published studies.…”