Cervical cytology with a diagnosis of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H): a follow-up study with corresponding histology and significance of predicting dysplasia by human papillomavirus (HPV) DNA testing.

Archives of gynecology and obstetrics

PubMedID: 24002355

Gilani SM, Tashjian R, Fathallah L. Cervical cytology with a diagnosis of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H): a follow-up study with corresponding histology and significance of predicting dysplasia by human papillomavirus (HPV) DNA testing. Arch Gynecol Obstet. 2013;.
OBJECTIVES
To evaluate the clinical significance of "atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion" ASC-H by comparing the original cytologic findings with follow-up tissue biopsies, and its association with high-risk HPV.

METHODS
A total of 235,518 ThinPrep Pap tests were performed at our institution from January 2008 through December 2010, but only 727 (0.3 %) of these cases were diagnosed as ASC-H.

RESULTS
Of the 309 cases diagnosed as ASC-H on cytology for which follow-up histologic material was available, 120 (38.8 %) were definitively diagnosed as high-grade dysplasia (CIN 2/3) and 75 (24.2 %) showed features of low-grade dysplasia (CIN 1). We observed that the incidence of dysplasia in patients less than 30 years of age was 73.4 % (113/154) and 48.3 % (14/29) in patients greater than 49 years of age (p = 0.001). There were 71 cases for which high-risk HPV DNA testing was conducted. HPV DNA was found to be positive in 41 of the dysplastic cases (CIN 1 = 18 cases and CIN 2/3 = 23) and negative in six of the dysplastic cases (CIN1 = 2 and CIN2/3 = 4).

CONCLUSION
We conclude that cases diagnosed as ASC-H should be followed-up with caution as they are strongly associated with dysplasia of any grade (63.1 %), especially high-grade dysplasia (38.8 %). Reflex HPV DNA testing is an important predictor of dysplasia with a positive predictive value of 87.2 % in our study.