Reporting of atypical squamous cells, cannot exclude a high‐grade squamous intraepithelial lesion (ASC‐H) on cervical samples: Is it significant?

Abstract

"Atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion (ASC-H)" is a new diagnostic category in the 2001 Bethesda nomenclature system for cervical cytology. The purpose of this 7-mo retrospective study (March 1, 2002-September 30, 2002) was to evaluate the significance of ASC-H on cervical Thin Prep Pap Tests. During this period, 25 (0.27%) of 9,214 Pap Tests were diagnosed as ASC-H, 22 of which resulted in either follow-up cervical biopsies and/or cervical cones, and which formed the basis of this study. Tissue specimens (22 cases) were negative in 5 cases (23%) and positive in 17 cases (77%). Of the positive specimens, there were 2 (12%) low-grade squamous intraepithelial lesions (LSIL) and 15 (88%) high-grade squamous intraepithelial lesions (HSIL). Of the 22 cases, ASC-H diagnoses included immature/atypical squamous metaplasia vs. a squamous intraepithelial lesion (SIL) in 19 (86%) cases, and tight clusters of small cells with a high nuclear to cytoplasmic ratio in 3 (14%) cases. The results of this study indicate that the reporting of ASC-H on cervical samples does lead to the detection of HSILs in a significant number of cases (68% in this study). Therefore, further evaluation of the patient is warranted.

Follow-up of women with atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions (ASC-H)

“…18 This is consistent with the results obtained from the majority of the studies observed, which demonstrated CIN II+ prevalences of more than 40%, according to the biopsy results. 3,5,6,[17][18][19][20][21][22][23][24]29 Our results confirmed that at the time of the first ASC-H report, immediate intervention with colposcopy was necessary, followed by a biopsy. This validates the medical management of ASC-H that is required by the "management algorithm from the time of the first atypical Pap, " which is included in the Chilean Ministry of Health's Clinical Guidelines for Cervical Cancer.…”

Follow up of Atypical Squamous Cell Pap Smears in Iraqi Women

“…These findings fall within the rate ranges reported in different studies (Table 4). The wide ranges of ASC-US (1.2-39%) and, to a lesser extent, ASC-H (0.06-2%) may be contributed to the Bethesda system applied for categorization of ASC into ASC-US and ASC-H and further subcategorization of ASC-US into reactive and neoplastic counterparts (NCI Bethesda System, 2001;Solomon et al, 2001Selvaggi, 2003Barcelos et al, 2011). In addition, the heterogeneous morphology and lack of well-defined criteria for both ASC-US and ASC-H reflected in their poor interobserver agreement between laboratories or even the variable experience of the microscopists may account for these differences (Saad et al, 2006;Chivukula and Shidham;CytrynI et al, 2009;Tewari and Chaudhary., 2010;Barcelos et al, 2011).…”

“…Being equivocal, the term ASC is categorized by The Bethesda System (TBS) 2001 into atypical squamous cells of undetermined significance (ASC-US) where the cytologic changes are suggestive of but, quantitatively or qualitatively, are insufficient for a definitive interpretation of squamous intraepithelial lesion (SIL) and into atypical squamous cells-cannot exclude high squamous intraepithelial lesion (ASC-H) where the atypical squamous cells exhibit some equivocal features suggestive of but not sufficient to call high squamous intraepithelial lesions (HSIL) (NCI Bethesda System, 2001;Selvaggi, 2003). In addition to the possible progression of ASC-US and ASC-H into HSIL or invasive malignancy, the link between these lesions and high risk-human papillomavirus (HR-HPV) creates…”

Histopathological Outcomes of Women with Abnormal Cervical Cytology: a Review of Literature in Thailand

“…In the recent study by Kingnate et al (2014), incidence of CIN 2-3/AIS and invasive lesion was 10.5% and 2.6%, respectively. In the literature, almost all studies evaluating histopathologic results of ASC-H smears were reported from North America where the incidence of cervical cancer appears to be relatively low (Alli and Ali, 2003;Louro et al, 2003;Selvaggi, 2003;Liman et al, 2005;Barreth et al, 2006;Saad et al, 2006;Srodon et al, 2006;McHale et al, 2007). The rate of underlying high-grade cervical lesion varied widely from 10% to 80%, in which less than 3.5% were invasive lesion (Alli and Ali, 2003;Louro et al, 2003;Selvaggi, 2003;Liman et al, 2005;Barreth et al, 2006;Saad et al, 2006;Srodon et al, 2006;McHale et al, 2007).…”