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

Gilani, Syed M.; Tashjian, Randy; Fathallah, Lamia

doi:10.1007/s00404-013-3015-5

Cited by 17 publications

(26 citation statements)

References 16 publications

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“…Despite these, the majority of Pap smears can be assigned into specific categories [4]. ASC-H is an uncommon cytology interpretation with an estimated incidence of 0.27-0.56% [11].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that ASC-H is associated with a higher incidence of high-grade histological lesions than ASC-US [2,3,4]. The aim of the present study is to review the cases of ASC-H diagnosed at a single institution and discuss the clinical management in these cases.…”

Section: Introductionmentioning

confidence: 99%

“…Screening for and detection of pre-invasive disease have turned cervical cancer into a potentially preventable gynecologic malignancy [3]. The Pap smear plays a central role in this early detection of malignancy, being a simple, cost-effective, and accurate process [4]. …”

Section: Introductionmentioning

confidence: 99%

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Clinical Relevance of ASC-H Cytologies: Experience in a Single Tertiary Hospital

Arco

Montoro²,

D³

et al. 2016

Acta Cytologica

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Objectives: To review the cases of atypical squamous cells (ASC), cannot exclude squamous intraepithelial lesion (ASC-H) diagnosed at a single institution and to discuss the interpretation challenges and clinical management of these cases. Study Design: The ASC-H cases diagnosed at our institution from 2006 to 2015 were studied retrospectively; of 159,000 Pap smears, there were 959 cases of ASC of undetermined significance (ASC-US) and 148 cases of ASC-H. We have reviewed the clinical records of the ASC-H cases, and data have been analyzed using SPSS 20.0. Results: Median age was 43.1 years; 49.6% of the patients had previous cervical cytologies, and 55.9% of them were negative. Following ASC-H diagnosis, another smear was obtained in 97.1% of the cases and in 67.6% a biopsy was performed. Biopsy revealed low-grade dysplasia in 18.8% of the cases, high-grade dysplasia in 27.8%, and infiltrating carcinoma in 2.3%. Patients with significant lesions in histology were younger than patients with negative results (p = 0.08). A diagnosis of ASC-H/squamous intraepithelial lesion in the repeated cytology had a sensitivity of 74.2%, specificity of 39.6%, positive predictive value of 44.8%, and negative predictive value of 70% for the diagnosis of dysplasia. Conclusions: ASC-H diagnosis is associated with a high incidence of histological high-grade lesions. A repeat cytology can aid in the selection of high-risk patients, but there may be false-negative results.

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“…Despite these, the majority of Pap smears can be assigned into specific categories [4]. ASC-H is an uncommon cytology interpretation with an estimated incidence of 0.27-0.56% [11].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Relevance of ASC-H Cytologies: Experience in a Single Tertiary Hospital

Arco

Montoro²,

D³

et al. 2016

Acta Cytologica

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“…Accumulating evidence from several studies over the past few years supports the role of reflex HPV DNA testing in the initial diagnostic approach for patients with ASC-H on cytology, although many of these previous studies included only limited cases with ASC-H and HPV-negative results [12][13][14][20][21][22][23][24]. These previous studies reported NPVs of .90% of HPVnegative results accompanying ASC-H for predicting highgrade CIN lesions (CIN $2), consistent with the NPV of 91.2% obtained in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…Both the current ASCCP and Korean guidelines recommend initial colposcopy with biopsy for women with Papanicolaou test (Pap test) results showing ASC-H, regardless of the HPV test results; however, there have been ongoing debates about the clinical significance and utility of the HPV test for the management of ASC-H [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Reflex Human Papillomavirus Test Results as an Option for the Management of Korean Women With Atypical Squamous Cells Cannot Exclude High-Grade Squamous Intraepithelial Lesion

et al. 2015

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Background. Current guidelines recommend initial colposcopy with biopsy regardless of human papillomavirus (HPV) test results in women with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H). The purpose of this study was to evaluate the value of HPV testing in women with ASC-H based on colposcopic pathology results. Materials and Methods. A multicenter cross-sectional study was carried out at three academic hospitals and involved 40,847 Korean women who underwent cervical cancer screening with cytology and HPV tests with or without subsequent colposcopic biopsies between January 2007 and December 2013. Results. ASC-H was diagnosed in 276 women (0.7%). Only 6 of 68 (8.8%) women with ASC-H who were HPV negative had cervical intraepithelial neoplasia grade $2 (CIN $2) lesions, whereas

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Triage of ASC‐H: A meta‐analysis of the accuracy of high‐risk HPV testing and other markers to detect cervical precancer

Verdoodt

Wentzensen

et al. 2015

Cancer Cytopathology

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Background Women with a cytological diagnosis of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) are usually immediately referred to colposcopy. However, triage may reduce the burden of diagnostic work-up and avoid over-treatment. Methods A meta-analysis was conducted to assess the accuracy of hrHPV testing, and testing for other molecular markers to detect CIN of grade II or III or worse (CIN2+ or CIN3+) in women with ASC-H. An additional question assessed was whether triage is useful given the relatively high pre-triage probability of underlying precancer. Results The pooled absolute sensitivity and specificity for CIN2+ of HC2 (derived from 19 studies) was 93% (95% CI: 89–95%) and 45% (95% CI: 41–50%), respectively. The p16INK4a staining (only 3 studies) has similar sensitivity (93%, 95% CI:75–100%) but superior specificity (specificity ratio: 1.69) to HC2 for CIN2+. Testing for PAX1 gene methylation (only 1 study) showed a superior specificity of 95% (specificity ratio: 2.08). The average pre-test risk was 34% for CIN2+ and 20% for CIN3+. A negative HC2 result decreased this to 8% and 5%, whereas a positive result upgraded the risk to 47% and 28%. Conclusions Due to the high probability of precancer in ASC-H, the utility of triage is limited. The usual recommendation to refer women with ASC-H to colposcopy is not altered by a positive triage test, whatever the test used. A negative hrHPV DNA or p16INK4a test may allow for repeat testing but this recommendation will depend on local decision thresholds for referral.

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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

Cited by 17 publications

References 16 publications

Clinical Relevance of ASC-H Cytologies: Experience in a Single Tertiary Hospital

Clinical Relevance of ASC-H Cytologies: Experience in a Single Tertiary Hospital

Reflex Human Papillomavirus Test Results as an Option for the Management of Korean Women With Atypical Squamous Cells Cannot Exclude High-Grade Squamous Intraepithelial Lesion

Triage of ASC‐H: A meta‐analysis of the accuracy of high‐risk HPV testing and other markers to detect cervical precancer

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