Archives of Gynecology and Obstetrics

, Volume 289, Issue 3, pp 645–648 | Cite as

Cervical cytology with a diagnosis of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H): a follow-up study with corresponding histology and significance of predicting dysplasia by human papillomavirus (HPV) DNA testing

Gynecologic Oncology
First Online:
Received:
Accepted:

Abstract

Objectives

To evaluate the clinical significance of “atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion” ASC-H by comparing the original cytologic findings with follow-up tissue biopsies, and its association with high-risk HPV.

Methods

A total of 235,518 ThinPrep Pap tests were performed at our institution from January 2008 through December 2010, but only 727 (0.3 %) of these cases were diagnosed as ASC-H.

Results

Of the 309 cases diagnosed as ASC-H on cytology for which follow-up histologic material was available, 120 (38.8 %) were definitively diagnosed as high-grade dysplasia (CIN 2/3) and 75 (24.2 %) showed features of low-grade dysplasia (CIN 1). We observed that the incidence of dysplasia in patients less than 30 years of age was 73.4 % (113/154) and 48.3 % (14/29) in patients greater than 49 years of age (p = 0.001). There were 71 cases for which high-risk HPV DNA testing was conducted. HPV DNA was found to be positive in 41 of the dysplastic cases (CIN 1 = 18 cases and CIN 2/3 = 23) and negative in six of the dysplastic cases (CIN1 = 2 and CIN2/3 = 4).

Conclusion

We conclude that cases diagnosed as ASC-H should be followed-up with caution as they are strongly associated with dysplasia of any grade (63.1 %), especially high-grade dysplasia (38.8 %). Reflex HPV DNA testing is an important predictor of dysplasia with a positive predictive value of 87.2 % in our study.

Keywords

Atypical squamous cells High grade Cervical biopsy HPV Follow-up 
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Notes

Conflict of interest

We declare that we have no conflict of interest.

References

  1. 1.
    Sherman ME, Abdul-Karim FW, Berek JS, Powers CN, Sidawy MK, Tabbara SO (2004) Atypical squamous cells. In: Solomon D, Nayar R (eds) The Bethesda System for Reporting Cervical Cytology, 2nd edn. Springer, New York, pp 67–68CrossRefGoogle Scholar
  2. 2.
    Galliano GE, Moatamed NA, Lee S, Salami N, Apple SK (2011) 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. Acta Cytol 55:167–172PubMedCrossRefGoogle Scholar
  3. 3.
    Alli PM, Ali SZ (2003) Atypical squamous cells of undetermined significance—rule out high-grade squamous intraepithelial lesion: cytopathologic characteristics and clinical correlates. Diagn Cytopathol 28:308–312PubMedCrossRefGoogle Scholar
  4. 4.
    Selvaggi SM (2003) Reporting of atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion (ASC-H) on cervical samples: is it significant? Diagn Cytopathol 29:38–41PubMedCrossRefGoogle Scholar
  5. 5.
    Louro AP, Roberson J, Eltoum I, Chhieng DC (2003) Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion. A follow-up study of conventional and liquid-based preparations in a high-risk population. Am J Clin Pathol 120:392–397PubMedCrossRefGoogle Scholar
  6. 6.
    Mokhtar GA, Delatour NL, Assiri AH, Gilliatt MA, Senterman M, Islam S (2008) Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion: cytohistologic correlation study with diagnostic pitfalls. Acta Cytol 52:169–177PubMedCrossRefGoogle Scholar
  7. 7.
    McHale MT, Souther J, Elkas JC, Monk BJ, Harrison TA (2007) Is atypical squamous cells that cannot exclude high-grade squamous intraepithelial lesion clinically significant? J Low Genit Tract Dis 11:86–89PubMedCrossRefGoogle Scholar
  8. 8.
    Wright TC Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D (2007) For the 2006 American Society for Colposcopy and Cervical Pathology (ASCCP)-sponsored consensus conference. 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol 197:346–355PubMedCrossRefGoogle Scholar
  9. 9.
    Wright TC Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D (2007) 2006 consensus guidelines for the management of women with abnormal cervical screening tests. J Low Genit Tract Dis 11:201–222PubMedCrossRefGoogle Scholar
  10. 10.
    Patton AL, Duncan L, Bloom L, Phaneuf G, Zafar N (2008) Atypical squamous cells, cannot exclude a high-grade intraepithelial lesion and its clinical significance in postmenopausal, pregnant, postpartum, and contraceptive-use patients. Cancer 114:481–488PubMedCrossRefGoogle Scholar
  11. 11.
    Kietpeerakool C, Srisomboon J, Tantipalakorn C, Suprasert P, Khunamornpong S, Nimmanhaeminda K, Siriaunkgul S (2008) Underlying pathology of women with “atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion” smears, in a region with a high incidence of cervical cancer. J Obstet Gynaecol Res 34:204–209PubMedCrossRefGoogle Scholar
  12. 12.
    Bandyopadhyay S, Austin RM, Dabbs D, Zhao C (2008) Adjunctive human papillomavirus DNA testing is a useful option in some clinical settings for disease risk assessment and triage of females with ASC-H Papanicolaou test results. Arch Pathol Lab Med 132:1874–1881PubMedGoogle Scholar
  13. 13.
    Sherman ME, Castle PE, Solomon D (2006) Cervical cytology of atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H): characteristics and histologic outcomes. Cancer 108:298–305PubMedCrossRefGoogle Scholar
  14. 14.
    Reid-Nicholson M, Gatscha RM, Riedel ER, Lin O (2007) Atypical squamous cells, cannot exclude high grade intraepithelial lesion (ASC-H): does HPV matter? Diagn Cytopathol 35:1–5PubMedCrossRefGoogle Scholar
  15. 15.
    Evans MF, Adamson CS, Papillo JL, St John TL, Leiman G, Cooper K (2006) Distribution of human papillomavirus types in ThinPrep Papanicolaou tests classified according to the Bethesda 2001 terminology and correlations with patient age and biopsy outcomes. Cancer 106:1054–1064PubMedCrossRefGoogle Scholar
  16. 16.
    Gupta S, Sodhani P, Chachra KL, Singh V, Sehgal A (2007) Outcome of “atypical squamous cells” in a cervical cytology screening program: implications for follow up in resource limited settings. Diagn Cytopathol 35:677–680PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Syed M. Gilani
    • 1
  • Randy Tashjian
    • 1
  • Lamia Fathallah
    • 1
  1. 1.Department of PathologySt. John Hospital and Medical CenterDetroitUSA

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