Living with uncertainty: Equivocal Pap test results and the evolution of ASC terminology

Abstract

Communication of equivocal findings and their significance has been a significant challenge related to Pap testing throughout its history. Terminology to report these findings has changed considerably to accommodate the changes in understanding of cervical neoplasia, and to accommodate new management strategies, tests, and technologies. This article reviews the evolution of terminology for equivocal Pap test findings from the original Papanicolaou classification to the current the Bethesda System 2001 atypical squamous cells terminology, the implication and use of these terms, and the changing landscape of cervical neoplasia screening, which prompted these terminology changes. Emerging issues related to improving risk stratification through the introduction of additional terms and the impact of human papillomavirus testing may alter terminology of equivocal findings in the future.

Likelihood of Neoplasia for Diagnoses Modified by Probability Terms in Canine and Feline Lymph Node Cytology: How Probable Is Probable?

“…A written cytology report is the principal means by which diagnostic results are communicated from the clinical pathologist to the clinician ( 1 , 2 ). Uncertainty is inherent in many cytology and pathology diagnoses, with certainty being affected by the quality of sample, type of lesion, pathologist experience, and availability of patient information ( 2 – 4 ). Pathologists, like other medical professionals ( 5 ), often convey the uncertainty or probability of a diagnosis using descriptive terms, such as “probable,” “suggestive,” and “compatible with” ( 3 , 6 – 9 ).…”

“…Pathologists, like other medical professionals ( 5 ), often convey the uncertainty or probability of a diagnosis using descriptive terms, such as “probable,” “suggestive,” and “compatible with” ( 3 , 6 – 9 ). However, there is wide variation and overlap in how such terms are interpreted by pathologists and by clinicians ( 3 , 4 , 6 – 9 ). This can contribute to miscommunication and has been shown to affect clinical management and decision-making, including the decision to euthanize ( 10 , 11 ).…”