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Cervical cytology of atypical squamous cells–cannot exclude high‐grade squamous intraepithelial lesion (ASC‐H)
Author(s) -
Sherman Mark E.,
Castle Philip E.,
Solomon Diane
Publication year - 2006
Publication title -
cancer cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.21844
Subject(s) - medicine , squamous intraepithelial lesion , colposcopy , cervical intraepithelial neoplasia , cytology , confidence interval , gynecology , cervical cancer , cancer , gastroenterology , pathology
BACKGROUND The 2001 Bethesda System category of atypical squamous cells (ASC) denotes changes suggestive, but inconclusive for, a squamous intraepithelial lesion (SIL). ASC is subcategorized as: 1) “undetermined significance (ASC‐US),” when changes suggest low‐grade or indeterminate‐grade SIL and 2) “cannot exclude high‐grade squamous intraepithelial lesion (ASC‐H),” when a cancer precursor is suspected. METHODS To better define the characteristics of ASC‐H, the authors analyzed and compared human papillomavirus (HPV) testing data and outcomes after 2 years for participants in the Atypical Squamous Cells of Undetermined Significance Low‐Grade SIL Triage Study (ALTS), a randomized trial of 5060 women. RESULTS Among women with thin‐layer cytology findings of ASC‐H, 84% tested positive for HPV, 50% (95% confidence interval [95% CI], 41%‐60%) were diagnosed with cervical intraepithelial neoplasia (CIN) type 2+, and 30% (95% CI, 22‐39%) were diagnosed with CIN3+. Positive HPV tests and diagnoses of CIN2+ and CIN3+ were found to be more common among women with ASCH compared with those with ASC‐US, but the highest frequencies were found to be associated with high‐grade SIL. For women age < 35 years with ASC‐H, HPV detection exceeded 85%, whereas only 4 of 10 women (40%) age ≥35 years tested positive for HPV ( P = 0.009). CONCLUSIONS A finding of ASC‐H seems to confer a substantially higher risk for CIN2+ and CIN3+ than ASC‐US. Immediate colposcopy may be the appropriate management for young women with ASC‐H, but the utility of HPV testing for managing older women with ASC‐H requires additional study. Cancer (Cancer Cytopathol) 2006. © 2006 American Cancer Society.