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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
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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.

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We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Pathology, St. John Hospital and Medical Center, 22101 Moross Road, CCB-SB, Detroit, MI, 48236, USA

    Syed M. Gilani, Randy Tashjian & Lamia Fathallah

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  1. Syed M. Gilani
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  2. Randy Tashjian
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  3. Lamia Fathallah
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Correspondence to Syed M. Gilani.

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Gilani, S.M., Tashjian, R. & Fathallah, L. 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. Arch Gynecol Obstet 289, 645–648 (2014). https://doi.org/10.1007/s00404-013-3015-5

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  • DOI: https://doi.org/10.1007/s00404-013-3015-5

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