Prevalence of cervical intraepithelial neoplasia grades II/III and cervical cancer in patients with cytological diagnosis of atypical squamous cells when high-grade intraepithelial lesions (ASC-H) cannot be ruled out

Abstract

Prevalence of cervical intraepithelial neoplasia grades II/III and cervical cancer in patients with cytological diagnosis of atypical squamous cells when high-grade intraepithelial lesions (ASC-H) cannot be ruled out Prevalência de neoplasia intra-epitelial cervical graus II/III e câncer cervical nas pacientes com diagnóstico citológico de células escamosas atípicas, quando não se pode excluir lesão intra-epitelial de alto grau (ASC-H)Andréa RESULTS:The prevalence of CIN II/III in cases with ASC-H cytology was 19.29% (95% confidence interval, CI, 9.05-29.55%) and the risk of these lesions was greater among patients with ASC-H than with ASC-US cytology (prevalence ratio, PR, 10.42; 95% CI, 2.39-45.47; P = 0.0000764). Pre-invasive lesions were more frequently found in patients under 50 years of age with ASC-H cytology (PR, 2.67; 95% CI, 0.38-18.83); P = 0.2786998). There were no uterine cervical cancer cases. CONCLUSION:The prevalence of CIN II/III in patients with ASC-H cytology was significantly higher than with ASC-US, and division into ASC diagnostic subcategories had good capacity for discriminating the presence of pre-invasive lesions. RESUMO CONTEXTO E OBJETIVO:A última atualização do Sistema Bethesda dividiu a categoria de células escamosas atípicas de significado indeterminado (ASCUS) em ASC-US (de significado indeterminado) e ASC-H (quando não se pode excluir lesão intra-epitelial de alto grau). Os objetivos deste estudo foram medir a prevalência da lesão pré-invasiva (Neoplasia Intra-epitelial Cervical, NIC II/III) e câncer cervical, de pacientes que foram encaminhadas ao Instituto Fernandes Figueira (IFF), com citologia ASC-H e compará-la com os casos ASC-US. RESULTADOS: A prevalência de NIC II/III na citologia ASC-H foi de 19,29% (intervalo de confiança, IC 95% 9,05-29,55%) e o risco destas lesões foi maior entre as pacientes com citologia ASC-H comparado às pacientes com citologia ASC-US (razão de prevalência, RP = 10,42; IC 95% 2,39-45,47; P = 0,0000764). A lesão pré-invasiva na citologia ASC-H foi mais frequente abaixo dos 50 anos (RP = 2,67; IC 95% 0,38-18,83), P = 0,2786998. Não houve casos de câncer do colo do útero. TIPO DE ESTUDO E LOCAL:CONCLUSÕES: A prevalência de NIC II/III em pacientes com citologia ASC-H foi significativamente mais alta que a de ASC-US, e a divisão em subcategorias do diagnóstico ASC se mostrou com boa capacidade para discriminar a presença de lesões pré invasivas.

Atypical Squamous Cells: Cytopathological Findings and Correlation with HPV Genotype and Histopathology

“…Comparing the prevalent histopathological result in ASC cytologies, ASC-US was significantly associated with LSIL or better outcome, whereas ASC-H was more associated with HSIL or worst outcome, in agreement to other authors [4, 11, 40, 41]. In the present study, 13.33% of ASC-US and 64.71% of ASC-H biopsies resulted in HSIL or higher, quite significant numbers indicating a need for follow-up.…”

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

“…Onuma et al [20] concluded that ASC-H in pregnant women had a lower predictive value for an underlying H-SIL than the general population. Cytryn et al [21] divided their patients based on age into those <50 and >50 years, and the prevalence of ≥CIN II was 22.22 and 8.33%, respectively, but the difference was not significant. Saad et al [5] showed a positive predictive value of 22% for a diagnosis of ASC-H in perimenopausal women and 6% in postmenopausal women, and found a significant difference between the incidence of ≥CIN II in these two groups.…”

Follow up of Atypical Squamous Cell Pap Smears in Iraqi Women

“…The wide ranges of ASC-US (1.2-39%) and, to a lesser extent, ASC-H (0.06-2%) may be contributed to the Bethesda system applied for categorization of ASC into ASC-US and ASC-H and further subcategorization of ASC-US into reactive and neoplastic counterparts (NCI Bethesda System, 2001;Solomon et al, 2001Selvaggi, 2003Barcelos et al, 2011). In addition, the heterogeneous morphology and lack of well-defined criteria for both ASC-US and ASC-H reflected in their poor interobserver agreement between laboratories or even the variable experience of the microscopists may account for these differences (Saad et al, 2006;Chivukula and Shidham;CytrynI et al, 2009;Tewari and Chaudhary., 2010;Barcelos et al, 2011). The rate of Pap smears could be also influenced by the type of Pap test applied, the age group of the studied patients as well as the population sampled (Chivukula and Shidham, 2006;Saad et al, 2006;Sherman et al, 2006;Bandyopadhyay et al, 2008;Tewari and Chaudhary, 2010;Zhao et al, 2010).…”