Atypical squamous cells and low-grade squamous intraepithelial lesion in cervical cytology: cytohistological correlation and implication for management in a low-resource setting

Abstract

In a low-resource setting where human papillomavirus testing is unaffordable, the threshold for colposcopic referral and follow-up histology should be ASC rather than SIL.

Prevalence of High-Grade Intraepithelial Neoplasia in Patients with Cytology Presenting Atypical Squamous Cells of Undetermined Significance

“…CIN 3 and invasive squamous carcinomas were seen in 5.9 and 1.4%, respectively, of cases of atypical squamous cell, and these were not seen in low-grade squamous intraepithelial lesion. The authors demonstrated results similar to ours regarding the finding of high-grade lesions [18]. …”

“…Comparing our results with those of other resource-poor countries, Gupta et al [18], in India, suggested that, in a low-resource setting, HPV testing is unaffordable. They performed an audit of all cervical smears reported as atypical squamous cells and low-grade squamous intraepithelial lesions in order to determine their histological follow-up to define the threshold for colposcopic referral.…”

Generation of an atlas of the proximal femur and its application to trabecular bone analysis

“…The ALTS study demonstrated the value of subcategorizing ASC‐US and ASC‐H with 41% of ASC‐H cases having underlying high‐grade intraepithelial lesion (HSIL) as compared to 12% in ASC‐US cases 3. Other studies have also confirmed the significance of subtyping ASC cases into ASC‐H 4–9. The majority of the previous studies are on conventional cervical smears.…”

Outcome of SurePath™ cervical samples reported as borderline nuclear change by cytological subtype and high‐risk HPV status

“…Data in the literature suggests that ASC-H and B-HG are associated with a higher prevalence of clinically significant cervical lesions compared with ASC-US and B-NOS. [4][5][6][7][8] In spite of proposed changes to UK terminology suggested by the British Society for Clinical Cytology (BSCC) in 2008, 9 the terminology currently in use in the National Health Service Cervical Screening Programme (NHSCSP) 10 does not support the use of B-HG and allows for koilocytosis with equivocal nuclear changes to be included in the BNC rather than a mild dyskaryosis category, which is otherwise equivalent to a low-grade squamous intraepithelial lesion (LSIL). This reflects the view that koilocytosis may indicate low-risk HPV infection, which may be transient and is not usually associated with high-grade cervical intraepithelial neoplasia (CIN).…”

“…These categories are equivalent to BNC in squamous cells, not otherwise specified (B‐NOS) and BNC, high‐grade dyskaryosis cannot be excluded (B‐HG) in the UK. Data in the literature suggests that ASC‐H and B‐HG are associated with a higher prevalence of clinically significant cervical lesions compared with ASC‐US and B‐NOS 4–8 . In spite of proposed changes to UK terminology suggested by the British Society for Clinical Cytology (BSCC) in 2008, 9 the terminology currently in use in the National Health Service Cervical Screening Programme (NHSCSP) 10 does not support the use of B‐HG and allows for koilocytosis with equivocal nuclear changes to be included in the BNC rather than a mild dyskaryosis category, which is otherwise equivalent to a low‐grade squamous intraepithelial lesion (LSIL).…”