Atypical squamous cells of undetermined significance: Correlative histologic and follow-up studies from an academic medical center

Abstract

The diagnosis of ASCUS (atypical squamous cells of undetermined significance) was introduced in the 1988 Bethesda System for reporting cervical/vaginal cytologic findings. Outcome and appropriate management of patients with this diagnosis is not presently established. Criteria defining ASCUS are nuclear enlargement (2.5–3.0 times normal intermediate cell nucleus), mild nuclear hyperchromasia, smooth nuclear outlines with mild variation in nuclear size and shape, or else two, but not all three, cytologic criteria for human papilloma virus (HPV) cytopathic effect. All 668 cases reported as ASCUS from February 1992–December 1993 from our cytology laboratory were reviewed. These ASCUS cases represented 4.5% of all gynecologic cases diagnosed in that same time period. Of these, 284 (41%) had a subsequent colposcopic biopsy and/or endocervical curettage. The biopsied cases included 101 (36%) with condylomata, 38 (13%) with cervical intraepithelial neoplasia (CIN) I, 17 (6%) with CIN II, and 9 (3%) with CIN III. No cases of carcinoma were detected. Of patients with a cytologic diagnosis of ASCUS and subsequent cervical biopsy, 49% had low‐grade cervical intraepithelial neoplasia (LGSIL), either condyloma or CIN I. Nine percent had high‐grade cervical intraepithelial neoplasia, either CIN II or CIN III. These findings indicate that ASCUS defines cytologically a group of patients who may have either a concurrent or subsequent development of a squamous intraepithelial lesion (SIL). This forms a high‐risk group. The management of cases with a cytologic diagnosis of ASCUS should be at least as aggressive as that of LGSIL. Diagn. Cytopathol. 16:1–7, 1997. © 1997 Wiley‐Liss, Inc.

Reflex human papilloma virus infection testing detects the same proportion of cervical intraepithelial neoplasia grade 2-3 in young versus elderly women

“…11 The diagnosis of ASCUS is hampered by the lack of both reproducibility and specificity. 2,[12][13][14][15] Despite the finding that the majority of ASCUS cases show insignificant changes on histologic examination, the sheer volume of this category allows it to contribute Յ 39% of the total CIN2-3 detected within a routinely screened population. 16 That is perhaps the strongest argument for pursuing a better triage of patients with ASCUS.…”

Predicting CIN2+ when detecting HPV mRNA and DNA by PreTect HPV‐proofer and consensus PCR: A 2‐year follow‐up of women with ASCUS or LSIL pap smear

“…Histologically verified CIN has been found in 10 -60% of women with an ASCUS diagnosis, with CIN2/3 present in more than 5%. [3][4][5][6][7][8][9][10][11] Pap smear follow-up of women with an ASCUS smear fails to identify all women at higher risk of CIN2ϩ, suggesting that cervical cancer screening programs might benefit from implementing new diagnostic tests in the triage of women with equivocal Pap smears. 12 Infection with high-risk (HR) types of HPV is necessary for the development of ICC [13][14][15][16] and the expression of the E6/E7 oncogenes is necessary for conversion to and maintenance of malignancy in cervical tissue.…”

O diagnóstico de células escamosas atípicas em citologia oncológica cervical

“…De fato, uma compilação dos resultados obtidos entre os casos que tiveram o diagnóstico citológico de células epidermóides atípicas (ASCUS) mostra ampla distribuição de diagnósticos: colo normal entre 28 e 42% dos casos, lesões de baixo grau em 20 a 54 %, 5 a 18% de lesões de alto grau e 0,3 a 4% de neoplasias invasoras [7][8][9] . Num grande estudo longitudinal com seguimento de casos com diagnóstico de ASCUS observou-se que 10% das mulheres vieram a apresentar lesão de alto grau (seguimento de até 7 anos) e 0,6%, carcinoma invasor 10 .…”