Managing Atypical Squamous Cells of Undetermined Significance (ASCUS): Human Papillomavirus Testing, ASCUS Subtyping, or Follow-Up Cytology?

Hughes, Sarah; Sun, Deqin; Gibson, Cheryl; Bellerose, Bronya; Rushing, Lynda; Chen, Hao; Harlow, Bernard L.; Genest, David R.; Sheets, Ellen E.; Crum, Christopher P.

doi:10.1097/00006254-200207000-00014

Cited by 12 publications

(23 citation statements)

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“…Data from the current study support previous reports (Gonzalez et al, 1996;Malik et al, 1999;Hughes et al, 2002) that AFR is only rarely associated with coexistent SIL. Indeed, only LSIL were detected in AFR, and also in a substantially lower prevalence compared to ASC-US (5.6% versus 18.5%), while HSIL were not found in AFR but only in 4.3% of ASC-US.…”

Section: Discussionsupporting

confidence: 92%

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Atypical squamous cells of undetermined significance-favour reactive compared to atypical squamous cells of undetermined significance-favour dysplasia: association with cervical intraepithelial lesions and human papillomavirus infection

Giovannelli

Capra

Lama

et al. 2005

Journal of Clinical Virology

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Section: Discussionsupporting

confidence: 92%

“…The role of HPV triaging in AFR has been less analysed. Few studies examined the association of different types of ASC, also including AFR, and HPV infection (Crum et al, 1999;Hughes et al, 2002;Lonky et al, 2003). However, in all of them, a portion of ASC was classified as "not otherwise specified", also up to 67.0% of the cases analysed.…”

Section: Introductionmentioning

confidence: 99%

Atypical squamous cells of undetermined significance-favour reactive compared to atypical squamous cells of undetermined significance-favour dysplasia: association with cervical intraepithelial lesions and human papillomavirus infection

Giovannelli

Capra

Lama

et al. 2005

Journal of Clinical Virology

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“…Studies on subclassification of ASCUS smears have found it useful to divide smears with atypical squamous cells into "of undetermined significance" (ASC-US) and "cannot exclude HSIL (ASC-H)," 38 and this classification is now a part of the Bethesda classification revised in 2001. 39 The Norwegian category of ASCUS is practically identical to the Bethesda category ASC-US: the subgroup ASC-H is a separate entity requiring colposcopy and biopsy 23 in the Norwegian screening guidelines and therefore was included in the HSIL category in this study; hence, the newer ASC-US diagnosis is probably also an indication of high risk.…”

Section: Consequences Of An Ascus Pap Smear In a Screening Programmentioning

confidence: 99%

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

Nygård

Sauer²,

Skjeldestad³

et al. 2003

Acta Cytologica

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“…Testing for HPV was conducted by using a general/consensus primer based GP5þ/ GP6þ polymerase chain reaction (PCR) enzyme immunoassay (EIA) for 14 high risk types (16,18,31,33,35,39,45, 51, 52, 56, 58, 59, 66 and 68). 25 This test has been clinically validated.…”

Section: Human Papillomavirus Testingmentioning

confidence: 99%

“…13,14 Consequently, HPV-testing may play an important role in clinical practice, i.e., in triage of women with BMD cytology, as an adjunct to cytology in primary screening and in posttreatment protocols. [15][16][17] The prevalence of hrHPV in women with BMD smears is about 35% 18,19 and it is likely that hrHPV negative BMD women are not at risk for development of high-grade CIN lesions or carcinoma. Hence, triage with hrHPV testing may improve the selection of women at risk for development of cervical cancer and consequently the management of women with BMD smears.…”

mentioning

confidence: 99%

Triage using HPV‐testing in persistent borderline and mildly dyskaryotic smears: Proposal for new guidelines

Bais

Rebolj

Snijders

et al. 2005

Intl Journal of Cancer

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In the Netherlands 2% of cervical smears in the cervical cancer screening program are read as borderline or mildly dyskaryotic cytology (BMD smear). Only in about 10% of these women a highgrade CIN lesion (CIN II-III) is present; therefore referral is for the majority unnecessary. In our study triage with high-risk HPV (hrHPV) testing was used to identify women at risk for development of high-grade CIN lesions after a repeat BMD smear. A ''wait-and-see'' period was incorporated allowing clearance of HPV and regression of the lesion. Women with a low-grade lesion, irrespective of their HPV status, were monitored at 12 months; women with a high-grade lesion were monitored at 6 and 12 months. Fifty-one of the 105 women (49%) were hrHPV negative at baseline; none of them showed progression of the lesion within the first year of follow-up (NPV 100%). High-grade CIN was present in 1 patient who was HPV negative at baseline (2%); she demonstrated regression after 12 months. Nineteen of the hrHPV positive women (35%) demonstrated a high-grade CIN lesion at baseline and 3 cleared hrHPV after 6 months, with a subsequent regression of CIN. Ten women remained hrHPV positive with persistence of high-grade CIN and were eventually treated. At baseline, 35 hrHPV positive women demonstrated a low-grade lesion, 19 remained hrHPV positive after 12 months and 5 developed high-grade CIN. Sixteen out of the 35 cleared the hrHPV infection without progression of the lesion. In conclusion, triage, using hrHPV testing for women with persistent BMD cytology, can select women who are not at risk for development of high-grade CIN. We recommend return to the screening program without referral for colposcopic examination if hrHPV is absent. For hrHPV positive women, a repeat hrHPV test after another 6 months is suggested. Referral is only required if persistence of hrHPV is established. ' 2005 Wiley-Liss, Inc.Key words: HPV; triage; borderline or mild dyskaryosis; guidelinesIn the Dutch population-based cervical cancer-screening program, women between 30 and 60 years of age undergo a cytological smear every 5th year. Recent surveys showed that about 2% of these smears contained borderline or mildly dyskaryotic (BMD) changes. 1,2 According to current screening guidelines, in these cases cytology is repeated after 6 months and (if negative) after 12 months. When cytology is persistently abnormal, women are referred to the gynaecologist where colposcopic examination is performed and a biopsy is taken for histological examination. When histology shows no or low-grade dysplasia ( CIN I) women will be kept under cytological surveillance without immediate treatment. High-grade dysplasia (CIN II-III) or a worse lesion will be treated. Only 10% of women with a single BMD smear show a high-grade CIN lesion. [3][4][5][6] Consequently, there is a need for an improved risk assessment of women with BMD.Infection with high-risk HPV (hrHPV) has been established as an important etiological factor in the carcinogenesis of cervical cancer. 7,8 Persistence of hr...

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Managing Atypical Squamous Cells of Undetermined Significance (ASCUS): Human Papillomavirus Testing, ASCUS Subtyping, or Follow-Up Cytology?

Cited by 12 publications

References 0 publications

Atypical squamous cells of undetermined significance-favour reactive compared to atypical squamous cells of undetermined significance-favour dysplasia: association with cervical intraepithelial lesions and human papillomavirus infection

Atypical squamous cells of undetermined significance-favour reactive compared to atypical squamous cells of undetermined significance-favour dysplasia: association with cervical intraepithelial lesions and human papillomavirus infection

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

Triage using HPV‐testing in persistent borderline and mildly dyskaryotic smears: Proposal for new guidelines

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