Long‐term follow‐up of women with atypical squamous cells of undetermined significance (ASCUS)

Abstract

ASCUS is the most common epithelial abnormality diagnosed in cytology laboratories in the US. Recently, the clinical importance of this diagnosis has been seriously questioned, with some investigators advocating elimination of this diagnostic category. This might be inappropriate if the ASCUS designation does define a population that is at significant risk for the development of dysplasia. Cytology and surgical pathology reports for all patients diagnosed as ASCUS in our laboratory during 1990 were reviewed. Patients with previous dysplasia or carcinoma were excluded from analysis. The pathology reports for the subsequent 9.1 yr were obtained and follow-up data collected. In 1990, 15,860 cervical cytology cases were examined in our laboratory. A diagnosis of ASCUS was made in 1,117 cases (7.0%). After excluding 345 patients with previous dysplasia or human papillomavirus-related diagnoses and 129 patients with no follow-up specimens, 643 study patients remained. Among these, the mean number of subsequent cervical smears was 4.3 (range, 1-18). Subsequent histologic material was available for 134 (20.8%) patients and the mean number of surgical specimens was 1.5 (range, 1-10). Squamous intraepithelial lesion (SIL) or dysplasia was subsequently diagnosed in 197 patients (30.6%). High-grade squamous intraepithelial lesion (HSIL) or at least moderate dysplasia was diagnosed in 64 patients (10.0%). In 21 cases (3.3%) the high-grade dysplasia developed more than 2 yr after the first ASCUS diagnosis. Follow-up disclosed no cases of invasive carcinoma. Among ASCUS patients followed for up to 9 yr, 20% develop only low-grade SIL or mild dysplasia and 10% develop HSIL or moderate or severe dysplasia. ASCUS should be retained as a diagnostic category since it identifies a significant percentage of patients who are at an increased risk for the development of cervical dysplasia.

Usefulness of liquid-based cytology specimens for the immunocytochemical study of p16 expression and human papillomavirus testing

“…27 As the definition of ASCUS has emphasized exclusion criteria rather than what criteria should be included in the category, it is inevitable that poorly sampled HSIL is interpreted as ASCUS. These facts have forced the introduction of new diagnostic criteria that can distinguish atypical squamous cells from HSIL (ASC-H) in the 2001 Bethesda system.…”

CIN 2/3 and Cervical Cancer After an ASCUS Pap Smear

“…This increased the proportion of women with CIN 2/3 or ICC to 10.7% at the end of the 7-year follow-up. Raab et al found that at the 6-year follow-up, CIN 2/3 had developed in 9% of women with ASCUS, 16 while a study by Emerson 17 found 10%.…”

“…[12][13][14][15] Long-term, population-based follow-up studies of women with an ASCUS Pap smear are fewer, but Raab et al found CIN 2/3 in 9.0% of women after 6 years of follow-up, with 80% diagnosed within the first 2 years of follow-up, 16 similar to the results found by Emerson et al in a 9-year follow-up study. 17 As much as 60% of women with an ASCUS Pap smear might harbor an underlying lesion at the time of the smear, but only approximately 10% will develop CIN 2/3. Hence, most CIN lesions will regress spontaneously, [18][19][20][21][22] and effective follow-up strategies are needed to identify the minority of women who have clinically significant disease while avoiding excessive follow-up evaluation for others.…”

Current possibilities of cervical precancerous lesions screening in Slovakia: prevalence of high risk human papillomavirus in patients with cytological diagnoses of atypical squamous cells of unknown significance

“…Emerson et al (13) analysed 15860 patients with cervical cytology a period of 9 years. Patients with previous dysplasia or carcinoma were excluded from analysis.…”