Histopathology of Women with “Atypical Squamous Cells Cannot Exclude High-Grade Squamous Intraepithelial Lesion” (ASC-H) Smears

Abstract

Objectives:To evaluate prevalence of underlying significant pathologies among women with cervical smears rated as ‘atypical squamous cells cannot exclude high grade squamous intraepithelial lesion (ASC-H)’, as well as associated risk factors.Methods:Medical records were reviewed of all consecutive women with ASC-H smears who had undergone colposcopy at Srinagarind Hospital from January 2008 to July 2016. Significant pathology results included cervical intraepithelial neoplasia (CIN) 2-3, adenocarcinoma in situ (AIS), endometrial hyperplasia, and cancer of any original site.Result:During the study period, 133 women with ASC-H were reviewed. The mean age was 45.3 years (range 21-72). The histopathologic results for the 133 women were as follows: no lesions (58; 43.6%), CIN 1 (34; 25.6%), CIN 2-3 (33; 24.8%), AIS (2; 1.5%), and cervical cancer (6; 4.5%). The overall rate of significant pathology was 30.8% (95% confidence interval, 22.9%-38.8%). Women younger than 40 years old carried a higher risk of harboring significant lesions when compared to older women (41.7% versus 27.8%, respectively). There was no significant impact of parity and menopausal status on the risk of significant pathology results.Conclusion:The rate of significant histopathologies among women with ASC-H smears in this study was approximately 31% and the associated risk factor was patient age.

Predictors of CIN2+ in Patients with PAP III-P (ASC-H): A Cross-Sectional Study

“…In this context, additional HR HPV testing in women over 40 years of age with ASC-H cytology was considered particularly helpful in identifying significant dysplasia [ 35 ] and a reasonable option for triage [ 37 ]. In contradiction with the findings addressed above [ 17 , 35 , 37 , 38 , 39 , 40 ], patient age was not identified as a significant predictor of CIN2+ in our analysis, as described in the results.…”

“…Several studies have identified age as an important factor in disease outcome in ASC-H patients, showing that younger women are more likely to display CIN2+ lesions than older patient groups [ 17 , 35 , 37 , 38 , 39 , 40 ]. Furthermore, it was demonstrated that in patients with ASC-H cytology, there is an age-dependent HR HPV positivity that is exceptionally high in younger patients and decreases with age [ 35 , 37 , 41 ].…”

Possible high‐grade squamous intraepithelial lesion (pHSIL) in the new cervical screening paradigm: The outcomes and the role of clinicopathological review

“…No association was found between the likelihood of HSIL and patient age (under vs over 40 years old) in our study. Studies have demonstrated that younger women have an increased risk of HSIL after referral with LBC/pap smear demonstrating ASC‐H/pHSIL 5,6,8,24 . The renewed NCSP screens women from the age of 25, whereas women were previously screened from the age of 18.…”

“…It is recommended that women with pHSIL be referred for colposcopy due to the likelihood of HSIL being found, with 12.2–65.6% of pHSIL cytology being found to have HSIL at colposcopy or on histology in international studies 5–11 . In Australia, an Australian Institute of Health and Welfare study 2 showed that in 2015, 38.4% of total pHSIL cytology results were found to have histologically confirmed HSIL, and 0.4% to have SCC.…”

“…Triaging ASC‐H/pHSIL results using hrHPV, as occurs in the renewed NCSP, increases the positive predictive value (PPV) of pHSIL 12–15 . In addition, women who were older, especially postmenopausal women, were less likely to have a finding of HSIL after a pHSIL result 8,13,16 . Older women diagnosed with pHSIL were more likely to have negative hrHPV and negative findings on histology and follow‐up 12–14 …”