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Clinical impact (cost‐effectiveness) of qualifying atypical squamous cells of undeterminate significance (ASCUS) in cases favoring a reactive or dysplastic process
Author(s) -
Carozzi F.M.,
Cariaggi M.P.,
Bonardi L.,
Bulgaresi P.,
Cecchini S.,
Ciatto S.,
Cipparrone I.,
Galanti L.,
Maddau C.,
Matucci M.,
Rubeca T.,
Troni G.M.,
Turco P.,
Zappa M.,
Confortini M.
Publication year - 2003
Publication title -
diagnostic cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.417
H-Index - 65
eISSN - 1097-0339
pISSN - 8755-1039
DOI - 10.1002/dc.10317
Subject(s) - ascus (bryozoa) , colposcopy , medicine , gynecology , squamous intraepithelial lesion , cervical intraepithelial neoplasia , cytology , liquid based cytology , vela , obstetrics , cervical cancer , pathology , cancer , biology , spore , botany , physics , ascospore , pulsar , astrophysics
The cost‐effectiveness of qualifying ASCUS cases into two different subcategories, favoring a reactive (ASCUS‐R) or dysplastic process (ASCUS‐S), was evaluated at the Centro per lo Studio e la Prevenzione Oncologica of Florence in a prospective study. The study determined the positive predictive value (PPV) for histologically confirmed cervical intraepithelial neoplasia grade 2 (CIN2) or more (CIN>) severe lesion of the two ASCUS subgroups. ASCUS‐S had a PPV (10.78%) comparable to low‐grade squamous intraepithelial lesions (LSIL) (11.40%). For ASCUS‐R cases, the recommendation of 6‐mo repeat cytology prompting colposcopy in cases of persistent ASCUS or more severe cytology was also effective, as it selected a subgroup with a relatively high PPV (10.34%). The cost‐effectiveness of a protocol based on ASCUS qualification was compared with two other possible options for nonqualified ASCUS cases: immediate colposcopy and colposcopy in persistent ASCUS at 6‐mo repeat cytology.. The detection rate of CIN2> was substantially higher using ASCUS qualification (35.9 vs 14.8 or 17.1). The cost per ASCUS subject was €24.99, 27.11, or 25.14 and that per CIN2> detected was €697, 1,831 or 1,470 for the three options, respectively. The evidence that ASCUS detection option implies a higher detection rate of CIN2> and subsequently a lower cost per CIN2> detection must be considered with caution and deserves confirmation by other comparative studies. Diagn. Cytopathol. 2003;29:4–7. © 2003 Wiley‐Liss, Inc.