Follow-up of women with atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions (ASC-H)

López-Alegría, Fanny; Lorenzi, Dino Soares De; Quezada, Orlando P.

doi:10.1590/1516-3180.2014.1321597

Cited by 6 publications

(2 citation statements)

References 25 publications

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“…28 The incidence of cervical cancer increased with the upgrading of cytology and was 3.1% and 5.4% in patients with low-grade and high-grade cytology, respectively, consistent with previously reported rates. 7,[29][30][31] However, 50.0% of early-stage cervical cancer was cytologic NILM/ASC-US in our study, which implied that the diagnostic performance of cytology was not satisfactory. The Slovenian study further indicated that underdiagnosed smears were not related to FIGO stage.…”

Section: Discussionmentioning

confidence: 78%

Optimizing the Detection of Occult Cervical Cancer: A Prospective Multicentre Study in China

Li¹,

Gong²,

Wang³

et al. 2021

IJWH

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Early-stage cervical cancer is usually diagnosed by colposcopy-directed biopsy (CDB) and/or endocervical curettage (ECC), but some neglected lesions must be detected by conization because they are occult. This study aimed to explore the optimal method for detecting these "occult" cervical cancers. Patients and Methods: A total of 1299 patients who were high-risk for early-stage cervical cancer from five centres in China were prospectively included. We evaluated the diagnostic performance of cytology, HPV testing, colposcopy and CDB&ECC for detecting "occult" cervical cancer and discussed the diagnostic importance of transformation zone (TZ) type, conization length and the proportion of cervical cone excision. Results:The diagnostic agreement between colposcopy impression and conization was 64.5% and 72.4% between CDB&ECC and conization. Forty-two patients were finally diagnosed with pathologic cancer, and the sensitivities of cytology, colposcopy, CDB&ECC were 4.8%, 7.1%, and 47.4%, respectively. Twenty cases were neglected by CDB&ECC but further diagnosed as cancer by conization, considered to be occult cervical cancer, accounting for 1.6%. Cytologic high-grade squamous intraepithelial lesion (HSIL)+, positive HPV, biopsy HSIL+ and cervical TZ type 3 were considered risk factors for developing HSIL+, while colposcopy impression HSIL+ was not. There was a significant difference between cancerous and HSIL patients in the proportion of cervical cone excision (P<0.001), which was recognized as a risk factor (P<0.001) for detecting cancer, while the length of cervical cone excision was not. The average proportion was 0.62, and the minimal effective proportion was 0.56. Conclusion: Since the incidence of occult cervical cancer neglected by CDB&ECC, colposcopy and cytology was far beyond expectations, conization is necessary, especially in patients with TZ type 3, high-grade cytology and biopsy results. As the cervical length varies in patients, the proportion of cervical cone excision might be a better indicator for detecting occult cervical cancer.

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Section: Discussionmentioning

confidence: 78%

Optimizing the Detection of Occult Cervical Cancer: A Prospective Multicentre Study in China

Li¹,

Gong²,

Wang³

et al. 2021

IJWH

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“…DiagnósTico hisTopaTológico en pacienTes con asc-h. (5) . Sin embargo, el estudio realizado por López-Alegría y col. muestra el resultado de 0,11% del total de Papanicolaous (9) .…”

Section: Métodos Resultadosunclassified

Correlación citohistológica de ASC-H en el Hospital Nacional Guillermo Almenara Irigoyen durante el período enero 2013 a julio 2015

Fernández

Chevarría

Cabrejos

2018

Rev peru ginecol obstet.

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En nuestro país, el cáncer de cuello uterino es aún la neoplasia maligna más frecuente en mujeres. Como prueba de tamizaje se utiliza el examen de Papanicolaou o citología cérvico-vaginal, el cual es informado utilizando el Sistema de Bethesda. En dicho sistema, la categoría ASC-H (atypícal squamous cells – cannot exclude HSIL-high grade squamous epithelial lesions, por sus siglas en inglés) designa los casos con presencia de células escamosas atípicas en las cuales los cambios son sugestivos de una lesión intraepitelial escamosa de alto grado pero insuficientes para una interpretación citopatológica definitiva, por lo que es importante determinar la correlación citohistológica de esta categoría. Objetivo. Correlacionar los resultados citopatológicos informados como ASC-H con los diagnósticos histopatológicos. Diseño. Estudio de tipo descriptivo, transversal y retrospectivo. Material. Citología cérvico-vaginal e histopatología. Métodos. Se revisó los casos con estudio citopatológico realizado entre enero de 2013 y julio de 2015, y con estudio histopatológico hasta un año después. Mediante la base de datos se determinó la cantidad poblacional y los diagnósticos. Se consideró como prueba de oro el diagnóstico histopatológico. Principales medidas de resultados. Correlación cito-histológica en casos de ASC-H. Resultados. Durante el período de estudio se realizaron 53 716 estudios de citología cérvico-vaginal convencional; de estos, 119 fueron catalogados como ASC-H; finalmente, 43 casos (0,07%) cumplieron los criterios de inclusión. El rango de edad de las pacientes fue de 22 a 70 años, siendo la media 43,8 años. El 42% de casos de ASC-H tuvo el diagnóstico de NIC2 y NIC3 en el estudio histopatológico. Conclusión. Se encontró una correlación entre los resultados de ASC-H y las lesiones intraepiteliales de alto grado (NIC II y NIC III), que concuerda con la encontrada en la bibliografía.

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Clinical Relevance of ASC-H Cytologies: Experience in a Single Tertiary Hospital

Arco

Montoro²,

D³

et al. 2016

Acta Cytologica

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Objectives: To review the cases of atypical squamous cells (ASC), cannot exclude squamous intraepithelial lesion (ASC-H) diagnosed at a single institution and to discuss the interpretation challenges and clinical management of these cases. Study Design: The ASC-H cases diagnosed at our institution from 2006 to 2015 were studied retrospectively; of 159,000 Pap smears, there were 959 cases of ASC of undetermined significance (ASC-US) and 148 cases of ASC-H. We have reviewed the clinical records of the ASC-H cases, and data have been analyzed using SPSS 20.0. Results: Median age was 43.1 years; 49.6% of the patients had previous cervical cytologies, and 55.9% of them were negative. Following ASC-H diagnosis, another smear was obtained in 97.1% of the cases and in 67.6% a biopsy was performed. Biopsy revealed low-grade dysplasia in 18.8% of the cases, high-grade dysplasia in 27.8%, and infiltrating carcinoma in 2.3%. Patients with significant lesions in histology were younger than patients with negative results (p = 0.08). A diagnosis of ASC-H/squamous intraepithelial lesion in the repeated cytology had a sensitivity of 74.2%, specificity of 39.6%, positive predictive value of 44.8%, and negative predictive value of 70% for the diagnosis of dysplasia. Conclusions: ASC-H diagnosis is associated with a high incidence of histological high-grade lesions. A repeat cytology can aid in the selection of high-risk patients, but there may be false-negative results.

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Follow-up of women with atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions (ASC-H)

Abstract: The follow-up on our cohort of women showed that the majority of uncertain ASC-H diagnoses (82.6%) had abnormal colposcopic results and that during the follow-up using ASC-H smears, two out of every three women developed high-grade lesions.

Cited by 6 publications

References 25 publications

Optimizing the Detection of Occult Cervical Cancer: A Prospective Multicentre Study in China

Optimizing the Detection of Occult Cervical Cancer: A Prospective Multicentre Study in China

Correlación citohistológica de ASC-H en el Hospital Nacional Guillermo Almenara Irigoyen durante el período enero 2013 a julio 2015

Clinical Relevance of ASC-H Cytologies: Experience in a Single Tertiary Hospital

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