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 1988Bethesda 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.

Cervical Papanicolaou smear abnormalities in inner city Bronx adolescents

“…Patients with initial ASCUS diagnoses showed SIL on follow-up in 30% of cases in the current study and corroborated previous studies [21][22][23] in which follow-up of ASCUS cases showed SIL rates of 34.7%, 49%, and 66.7%, respectively. Although there is interobserver variability in the diagnosis of ASCUS, 24 a diagnosis of ASCUS in the sexually active adolescent population has significant implications for the development of definite precursor cervical neoplasia.…”

Prevalence of abnormal Papanicolaou smears and cytohistological correlation: A study from Aga Khan University Hospital, Pakistan

“…This rate is lower in comparison with other studies done for ASCUS. [8][9][10][11][12][13] This is a subset of patients in which repeat a smear prior to biopsy, if persistent abnormality is encountered, is recommended by the National Health Service Cervical Screening Programme 14 document and CAP. 9 …”

Diagnosis of ?ASCUS? in women over age 50 is less likely to be associated with dysplasia

“…A range of outcomes has been found that generally centers around ASCUS being predictive of viral changes or dysplasia in 25-55% (the average of 12 studies was 34%) of cases and high-grade squamous intraepithelial lesions (HGSIL) in about 5-20% of cases (average, 9%), depending on the mechanism of follow-up. [2][3][4][5][6][7][8][9][10][11][12][13][14] These data have warranted increased attention to follow-up in ASCUS patients. 15 Due to demographics in the USA and the nature of cervical cancer, the majority of women participating in Papanicolaou (Pap) smear screening are under age 50.…”