Papanicolaou test interpretations of “atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion”

Abstract

Motivated by the potential difference between intramyocellular lipid (IMCL) and extramyocellular lipid (EMCL) in their microscopically restricted diffusion environments, proton diffusion properties in IMCL and EMCL were characterized by diffusion‐weighted magnetic resonance spectroscopy. Ex vivo experiments were conducted on fresh pig lower hindlimb muscle samples. In vivo experiments were performed on the lower hindlimbs of normal adult Sprague–Dawley rats. Ex vivo apparent diffusion coefficients at 20°C were found to be in the ranges of (10.8 ± 0.5) × 10−6 to (15.8 ± 0.8) × 10−6 mm2/s for EMCL and (1.6 ± 0.6) × 10−6 to (2.4 ± 0.7) × 10−6 mm2/s for IMCL depending on the diffusion weighting direction relative to muscle fiber orientation. In vivo apparent diffusion coefficients of EMCL and IMCL were measured as (13.8 ± 0.9) × 10−6 and (4.6 ± 0.7) × 10−6 mm2/s, respectively, along the direction perpendicular to muscle fiber orientation. Our results demonstrated that the apparent diffusion coefficient of EMCL was substantially higher than that of IMCL. Therefore, EMCL could be effectively suppressed by proper diffusion weighting to achieve reliable detection of IMCL despite unknown or/and multiple muscle fiber orientations. Such lipid proton diffusion approach can be used for robust IMCL separation and identification. Furthermore, it may provide new biophysical insights in the investigation of lipid metabolism in obesity and diabetes. Magn Reson Med, 2011. © 2011 Wiley‐Liss, Inc.

Reflex High Risk HPV Testing in Atypical Squamous Cells, Cannot Exclude High Grade Intraepithelial Lesion: A Large Institution’s Experience with the Significance of This Often Ordered Test

“…In our institution the ASC-H incidence was 0.2%, which falls into the lower range when compared to the literature [16,17,18,19,20,21,22,23,24,25,26,27,28]. The reported rate of subsequent surgical biopsy of high grade cervical intraepithelial neoplasia (CIN 2/3) after ASC-H ranges from 12.2 to 68.2% [3,4,22,25,29,30]. In general, the risk of high grade cervical dysplasia after a Pap diagnosis of ASC-H is greater than that seen in LSIL.…”

“…Several theories have been postulated including a regional variation in HPV prevalence and high interobserver variability in the initial ASC-H diagnosis (agreement as low as 20%) [12,14,31]. Certainly, inadequate follow-up duration may have contributed to differences in CIN 2/3 detection [29]. In a study by Bonvicino et al [29] in 500 ASC-H patients over an average follow-up of 18.5 months, 14% of the patients required a second follow-up biopsy and 8% a third follow-up biopsy to definitely diagnose CIN 2/3 after an ASC-H cytology (required 8 months of additional follow-up).…”

“…Certainly, inadequate follow-up duration may have contributed to differences in CIN 2/3 detection [29]. In a study by Bonvicino et al [29] in 500 ASC-H patients over an average follow-up of 18.5 months, 14% of the patients required a second follow-up biopsy and 8% a third follow-up biopsy to definitely diagnose CIN 2/3 after an ASC-H cytology (required 8 months of additional follow-up). …”

“…This population includes cervical samplings with poorly sampled cervical dysplasia, reactive or degenerative changes, or single rare cells which display high grade features. A negative HPV test may give clinicians a false sense that a high grade lesion is absent despite several studies showing a consistent association after ASC-H with high grade CIN 2/3, which is greater than the risk of LSIL and ASC-US [3,12,14,29,31]. …”

“…The cells with cytologic abnormalities are often sparse or, if sufficient in number, may only show some of the features of HSIL. The significance of a negative initial colposcopy after ASC-H is also uncertain and a management challenge given that it may take several procedures to diagnose a high grade lesion [29]. However, the literature has shown that even though ASC-H is an equivocal diagnosis for HSIL it should be taken no less seriously.…”