Atypical Squamous Cells of Undetermined Significance Cervical Cytology Report Rate and Histologic Follow-up Findings From the Largest College of American Pathologists–Certified Laboratory in China

Abstract

Context.— Reports for atypical squamous cells of undetermined significance (ASC-US) and histologic findings are rare in China. Objective.— To analyze the correlation findings of ASC-US cytology with high-risk human papillomavirus (hrHPV) test and histopathologic follow-ups. Design.— ASC-US cases with hrHPV test and histologic follow-ups between 2011 and 2015 were analyzed at a College of American Pathologists–certified laboratory. Results.— A total of 2 206 588 Papanicolaou (Pap) tests were performed, including 1 513 265 liquid-based cytology preparations (68.58%), and 693 323 conventional Pap tests (31.42%). The overall ASC-US reporting rate was 3.77% (83 199 of 2 206 588), with the highest in women aged 40 to 49 years. Of 18 574 women with ASC-US Pap and HPV testing, the hrHPV positivity rate was 34.98% (6498 of 18 574) with the highest in women younger than 30 years. A total of 6012 women with ASC-US Pap test findings had histologic follow-ups within 6 months; the overall cervical intraepithelial neoplasia 2 and above (CIN2+) detection rate was 7.87% (473 of 6012). One thousand nine hundred nine women with ASC-US Pap and HPV testing had histologic results. CIN2+ lesion was found in 13.98% (124 of 887) of women with ASC-US Pap/HPV-positive test results, significantly higher than 2.84% (29 of 1022) for women with ASC-US Pap/HPV-negative test results. Cervical squamous cell carcinoma was found in 3.95% (35 of 887) of women with ASC-US/HPV-positive test results. Conclusions.— This is one of the largest studies to investigate HPV and histologic follow-up findings in women with ASC-US in China. The ASC-US reporting rate, HPV positivity rate, and CIN2+ detection rate were all within the currently recognized benchmark ranges. These findings may contribute to establishing a baseline for better understanding of the status of cervical screening in China.

Immediate histologic correlation in women with atypical squamous cells of undetermined significance cytology and positive high‐risk HPV: A retrospective review of 6000 cases in a large academic women's hospital

“…Pooled hrHPV testing has been used routinely worldwide to stratify risk in women with ASC‐US cytology. Previous studies have shown that CIN2+ lesions are found in approximately 5%‐21.2% of women with ASC‐US/hrHPV+, though these findings are based predominantly on results obtained using the HC2 platform 15‐20,24 . Our results show that detection rates of CIN2+ lesions in women with ASC‐US/hrHPV+ using the hrHPV testing platforms HC2, Cervista, and Aptima are low (<10%) and that most women with ASC‐US/hrHPV+ do not harbor a high‐grade cervical lesion on immediate histologic follow‐up.…”

“…Recent studies have found a high prevalence of CIN2/3 in women aged 21‐24 years with ASC‐US cytology and have suggested that it may be prudent to consider alternative surveillance, such as colposcopy, in similar high‐risk populations 32,33 . In addition, a large‐scale study of ASC‐US in the Chinese population showed that the rate of hrHPV positivity decreased with increasing age and was highest in women aged <20 years 20 . In the present study, our results show that the immediate histologic correlation rates in the younger population were lower than those in older populations.…”

“…Numerous studies have demonstrated that these testing modalities show similar clinical accuracy in detecting cervical intraepithelial lesions in women with ASC‐US, but have certain discordant results when compared with one another 10,12‐14 . Investigation of hrHPV‐positive (hrHPV+) cases of ASC‐US predominately detected by the HC2 platform in different geographic populations and over variable follow‐up periods demonstrated variable detection rates of grade 2 CIN and higher (CIN2+) lesions on follow‐up histologic examination, ranging from 5% to 21.2% 15‐21 . At the Magee‐Womens Hospital of the University of Pittsburgh Medical Center (UPMC), a large academic women's health center, the HPV testing platform was switched from HC2 to Cervista in June 2013, then to the Aptima testing platform in June 2015.…”

Diagnostic Yield and Performance of a Large Population-Based Cervical Cancer Screening Program in High-Risk Rural China

“…As demonstrated by a population-based the study in Chinese population, ASC-US PPV was roughly 5% -17% [5] . Accordingly, ASC-US PPV in present study were 6.28% in CIN2+, 19.97% in CIN1 and 0.57% in squamous cell carcinoma, similar to 6.5% (29/446) CIN2+ detection rate by Lopez-Alegria F et al [22] .…”

“…According to the most recent Surveillance, Epidemiology, and End Results (SEER) data from 2012-2016, the incidence rate for cervical cancer had declined to 7.3/100,000 per year in the United States in contrast to 15.6/100,000 per year in China. Despite Ivyspring International Publisher of local efforts and international assistance to scale up effective cervical cancer prevention service [3][4][5] , about 80% cervical cancer burden from source-poor regions remains as a nationwide health issue [6][7][8] . Latest cervical cancer statistical studies have shown that more than 85% of cervical cancer patient in Shanxi Province had never received proper screening and presented at late stage.…”