Atypical squamous cells of undetermined significance: Interlaboratory comparison and quality assurance monitors

Davey, Diane D.; Naryshkin, Sonya; Nielsen, Mary L.; Kline, Tilde S.

doi:10.1002/dc.2840110416

Cited by 147 publications

(93 citation statements)

References 12 publications

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“…This situation is analogous to the introduction of atypical squamous cells of undetermined significance (ASCUS) with TBS for cervical/vaginal cytology, for which reporting the ratio of atypical smears to squamous precursor lesions (the ASCUS:squamous intraepithelial lesion [SIL] ratio) has become a widely accepted, although imperfect, performance measure. 15 The only such recommendation that accompanied TBS for thyroid cytopathology was that the AUS rate not exceed 7% 1 ; however, this proposal lacked a robust evidentiary basis and has proved to be unrealistic for many laboratories publishing their initial experiences with TBS. [2][3][4][5][6][7][8][9][10][11][12][13][14] In this study, we review the initial published experiences with AUS and TBS in conjunction with our own laboratory experiences, with the goal of identifying evidencebased performance measures that will have usefulness in measuring individual and laboratory practices.…”

Section: Introductionmentioning

confidence: 99%

The atypia of undetermined significance/follicular lesion of undetermined significance:malignant ratio

Krane

VanderLaan

Faquin

et al. 2011

Cancer Cytopathology

126

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BACKGROUND:The Bethesda System (TBS) for reporting thyroid cytopathology introduced the atypia of undetermined significance/follicular lesion of undetermined significance (AUS) category, but did not provide adequate guidance for the appropriate use of this diagnosis. In the current study, the authors sought to identify an appropriate measure for AUS use based on experience to date with TBS.METHODS:The authors reviewed 8 series, including their own laboratory experiences, with a total of 30,466 thyroid aspirates classified within TBS.RESULTS:The median AUS rate was 9.9% with a range of 3.0% to 18.0%. Use of the individual diagnostic categories within TBS varied up to 12.7‐fold. The ratio of “suspicious for follicular neoplasm” plus “suspicious for malignancy” to “malignant” (M) diagnoses varied the least (1.8‐fold). The AUS:M ratio provided a suitable measure of assessing AUS use, with a median ratio of 2.0 and a range of 0.5 to 4.9.CONCLUSIONS:Based on available studies, an AUS:M ratio of 1.0 to 3.0 is recommended. AUS:M ratios > 3.0 are likely because of overdiagnosis of AUS or underdiagnosis of M. AUS:M ratios < 1.0 are mostly due to low AUS rates, at the likely expense of sensitivity. Cancer (Cancer Cytopathol) 2012;. © 2011 American Cancer Society.

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Section: Introductionmentioning

confidence: 99%

The atypia of undetermined significance/follicular lesion of undetermined significance:malignant ratio

Krane

VanderLaan

Faquin

et al. 2011

Cancer Cytopathology

126

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“…These surveys have documented the widespread implementation of the first 2 versions of The Bethesda System, reporting rates for various cervical cytology categories and important benchmarking data for quality assurance. [1][2][3][4][5] Results of the Atypical Squamous Cells of Undetermined Significance (ASCUS) and Low-Grade Squamous Intraepithelial Lesion (LSIL) Triage Study established the role of high-risk HPV (HR-HPV) testing as a cost-effective triage strategy for atypical squamous lesions and led to development of the 2001 American Society for Colposcopy and Cervical Pathology (ASCCP) management guidelines. 6 The rapid adoption of HPV testing by many cytology laboratories during the next few years prompted the development and distribution of the 2003 CAP Supplemental Questionnaire to assess practice patterns in HPV testing.…”

mentioning

confidence: 99%

Human Papillomavirus Testing and Reporting Rates in 2012: Results of a College of American Pathologists National Survey

Zhao

Moriarty²,

Ghofrani³

et al. 2014

Archives of Pathology &Amp; Laboratory Medicine

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Context College of American Pathologists (CAP) surveys are used to establish national benchmarks for laboratory parameters. Objective To evaluate changes in laboratory human papillomavirus (HPV) testing patterns in laboratories incorporating HPV testing with Papanicolaou tests in 2012. Design Data were analyzed from the CAP HPV Supplemental Questionnaire distributed to 1771 laboratories participating in either CAP HPV or CAP Papanicolaou proficiency testing in 2013. Results A total of 1022 laboratories (58%) responded. There were more high-risk (HR) HPV tests performed per institution as compared to previous surveys. There were more HPV tests performed within an institution as compared to previous surveys. Hybrid Capture 2 (HC2) remains the most common method (42.4%, 239 of 564); Cervista and cobas methods are used in 37.2% (210 of 564) and 14.9% (84 of 564) of laboratories, respectively. Human papillomavirus testing is offered as a reflex test after a Papanicolaou test result of atypical squamous cells of undetermined significance (ASC-US) in 89.6% of laboratories (476 of 531); as a cotest for women aged 30 years and older in 60.3% (404 of 531); as reflex testing after atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) in 42.7% (320 of 531); and as reflex testing after atypical glandular cells (AGC) in 27.3% (145 of 531). The HPV-positive rates for ASC-US and ASC-H were similar in 2012 and 2006. Cervista (49.2%, 88 of 179) and Roche cobas (27.4%, 49 of 179) are the most common methods used for genotyping. Most laboratories use the CAP Human Papillomavirus for Cytology Program for proficiency testing. Conclusions There was an increase in annual volume of HR-HPV testing with a shift toward in-house HR-HPV testing. Genotyping volumes also increased. HC2 and Cervista are most commonly used, with an increasing volume of Roche cobas testing. The most common indication for HPV testing among all laboratories was ASC-US reflex testing, but an increase in HPV cotesting was observed. The data provide an update into persisting and newer trends in HPV testing practices.

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“…However, there is considerable interlaboratory variability in detection of SILs and up to 20% of SILs can go undetected by routine screening procedures [9][10][11][12] . Additionally 5-10% of women with the diagnosis of ASCUS harbor SILs and more than one-third of screening populations who harbor high-grade intraepithelial lesions are identified from ASCUS results 6 .…”

Section: Discussionmentioning

confidence: 99%

Human Papillomavirus Typing in HIV‐Positive Women

Hameed

Fernandes

Skurnick³

et al. 2001

Infectious Diseases in Obstetrics and Gynecology

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Objective: Human papillomavirus (HPV) is the major cause of cervical carcinoma and cervical intraepithelial neoplasia worldwide. Certain HPV types have a strong association with and probably a causative role in the pathogenesis of premalignant cervical lesions. Epidemiologic studies in women infected by the human immunodeficiency virus (HIV) have shown an increased incidence of squamous intraepithelial lesions (SILs), which were predominantly high-grade. Six to 30 per cent of women diagnosed with atypical squamous cells of undetermined significance (ASCUS) on a Papanicolaou (Pap) smear harbor SIL in normal screening populations. This study was undertaken to determine the presence of low-and high-risk HPV types in women infected by HIV and to correlate the results to those of the Pap smear. Study design: HPV DNA typing (low-and high-risk) by Digeneä (Digene Corporation, Gathesburg, MD) hybrid capture methodology was performed on cervical swabs from 209 HIV-positive women. The results of HPV typing were correlated with those of the Pap smear in a retrospective analysis. Results: One hundred and one women (48%) tested positive for HPV subtypes by DNA typing by the hybrid capture method. Of these, 64 patients (63%) had Pap smears which were read as being normal, having benign cellular changes, or having ASCUS (favor reactive process). Of these, 19 patients tested positive for both high-risk and low-risk subtypes, 32 patients tested positive only for high-risk subtypes, and 13 patients tested positive only for low-risk subtypes. Conclusion: HPV subtyping identifies a significant group of HIV-positive women who are at risk for developing cervical intraepithelial neoplasia, although they may not show significant abnormalities on their Pap smears.

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Atypical squamous cells of undetermined significance: Interlaboratory comparison and quality assurance monitors

Cited by 147 publications

References 12 publications

The atypia of undetermined significance/follicular lesion of undetermined significance:malignant ratio

The atypia of undetermined significance/follicular lesion of undetermined significance:malignant ratio

Human Papillomavirus Testing and Reporting Rates in 2012: Results of a College of American Pathologists National Survey

Human Papillomavirus Typing in HIV‐Positive Women

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