Significance of a diagnosis of atypical squamous cells of undetermined significance for Papanicolaou smears in perimenopausal and postmenopausal women

Abstract

BACKGROUND The current study was conducted to determine the significance of a diagnosis of atypical squamous cells of undetermined significance (ASCUS) in perimenopausal and postmenopausal women. METHODS The reports for all Papanicolaou (Pap) smears viewed in the study institution's cytology laboratory over a 6‐month period were reviewed. Women were divided into premenopausal (age ≤ 45 years), perimenopausal (ages 46–54 years), and postmenopausal (age ≥ 55 years) categories. Slide review and 2‐year follow‐up were obtained for selected cases diagnosed as ASCUS. ASCUS cases among the perimenopausal women were compared with an age‐matched control group. RESULTS The total number of abnormal Pap smears in the premenopausal, perimenopausal, and postmenopausal categories were 770 (6.8%), 104 (4.3%), and 67 (2.9%), with 482, 83, and 41 diagnoses of ASCUS, respectively. The ratio of ASCUS to squamous intraepithelial lesions (SIL) was 2.2 overall and 1.9, 7.5, and 4.1, respectively, for each group (P < 0.001). The positive predictive value for a diagnosis of SIL on subsequent Pap smears or biopsies was 22%, 12.2%, and 29.7%, respectively. Slide review showed that the premenopausal ASCUS cases appeared to have a higher percentage of nuclear‐cytoplasmic ratio increase and nuclear membrane irregularities compared with the other categories (P = 0.03 and P = 0.02, respectively) and the perimenopausal group was found to have more ASCUS in metaplastic cells (P = 0.03). In perimenopausal women, slides diagnosed as ASCUS demonstrated more air‐drying artifact than the control group (P = 0.004) but had less obvious atrophy (P = 0.01). CONCLUSIONS Despite a decreased abnormality rate with increasing age, the results of the current study show that the perimenopausal and postmenopausal groups appear to have elevated ASCUS‐to‐SIL ratios. ASCUS appears to have a particularly low positive predictive value for SIL in perimenopausal women, and therefore most likely is overcalled in this age group. This may be attributable in part to air‐drying artifact and subtle atrophic changes. Cancer (Cancer Cytopathol) 2001;93:100–105. © 2001 American Cancer Society.

Significance of High-Risk Human Papillomavirus DNA–Positive Atypical Squamous Cells of Undetermined Significance Pap Smears in Perimenopausal and Postmenopausal Women

“…This overall low positive rate for high risk HPV DNA in these perimenopausal and postmenopausal women has been explained as resulting from overdiagnosis of atrophy-related epithelial changes as ASCUS. 3,4 In addition, lower incidence of HPV infection or a lower viral load in infected individuals may also be contributing factors. Although a second spike of HPV positivity has been reported in women ≥ 55 years, 7 an obvious second spike of HPV positivity in these women was not observed in our study.…”

“…1,2 It has been speculated that atrophyassociated epithelial change and reactive metaplasia may cause overdiagnosis of ASCUS in these women. 3,4 Reflex testing for high-risk human papillomavirus (HPV) DNA in patients with ASCUS has been demonstrated to be highly sensitive for detecting cervical intraepithelial neoplasia (CIN) grade 3 (CIN 3), the precursor of cervical cancer, resulting in fewer women, both younger and older, being referred for colposcopy. 5,6 The overall sensitivity of HPV DNA testing at the 1.0 pg/mL level for detecting CIN 3 or cancer was reported to be 96.1% and varied minimally from 93.9% to 97.8% among women of different ages with an ASCUS interpretation.…”

Reflex human papilloma virus infection testing detects the same proportion of cervical intraepithelial neoplasia grade 2-3 in young versus elderly women

“…[5][6][7] Recently, a "second peak" of HPV infection prevalence has occurred among women Ն 50 years in several populations. 8,9 In addition to a tendency of the ASCUS-to-SIL ratio to increase with age, 10 this second peak of infection necessitates the evaluation of the performance of reflex HPV infection testing among older women. The objectives of the current study are to assess the age trends of SILs, ASCUS, and HPVϩASCUS and to determine the impact of these trends on the proportions of cervical intraepithelial neoplasia (CIN) lesions detected through reflex HPV-DNA testing among different age groups.…”

Prevalence and Typing of HPV DNA in Atypical Squamous Cells in Pregnant Women

“…However, the assay may be cost-effective in triage of older women since ASC appears to have low positive predictive value for SIL, and the HPV rate is significantly lower. 30,34,35 Benign cellular changes specific to this older group, such as epithelial metaplasia and atypia of atrophy and maturity, are known to contribute to the diagnosis of ASC. 36 A negative HPV result could lead to reduced surveillance of these women.…”