The Korean Journal of Cytopathology (대한세포병리학회지)

The Korean Society for Cytopathology (대한세포병리학회)
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Qualification of Atypical Squamous Cells of Undetermined Significance - "ASCUS, R/O HSIL" : Cytologic Features and Histologic Correlation

자궁경부 세포진에서 ASCUS 진단의 세분화 - "ASCUS, R/O HSIL" : 세포학적 소견 및 조직학적 상관성

  • Kim, Hye-Sun (Department of Pathology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, Bock-Man (Department of Pathology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, Yee-Jung (Department of Pathology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, Hy-Sook (Department of Pathology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine)
  • 김혜선 (성균관대학교 의과대학 삼성제일병원 진단병리과) ;
  • 김복만 (성균관대학교 의과대학 삼성제일병원 진단병리과) ;
  • 김의정 (성균관대학교 의과대학 삼성제일병원 진단병리과) ;
  • 김희숙 (성균관대학교 의과대학 삼성제일병원 진단병리과)
  • Published : 2002.06.30
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Abstract

Cytologic and histopathologic features and human papillomavirus (HPV) DNA detection associated with 101 cervicovaginal smears which are ciassified as 'atypical squamous cells of undetermined significance, rule out high grade squamous intraepithelial lesion(ASCUS, R/O HSIL)' were reviewed and compared to 89 smears of 'ASCUS, not otherwise specified(NOS)'. Cytologic fieatures of ASCUS, R/O HSIL included atypical single small cells(36.6%), hyperchromatic tissue flagments(35.6%), atypical metaplastic cells(18.8%), endometrial cell-like clusters(5.9%), and atypical parakeratotic cells(3.0%). A final diagnosis of HSIL on biopsy was assigned to 47(54.0%) of 87 women with ASCUS, R/O HSIL and to 13(14.6%) of 89 women with ASCUS, NOS (p=0.000). There was no difference in HPV DNA detection late between ASCUS, R/O HSIL and ASCUS, NOS smears. These data suggest that subclassification of ASCUS is helpful to manage patients because ASCUS, R/O HSIL is more often associated with an underlying HSIL on biopsy. Therefore, women with ASCUS, rule out HSIL should be actively managed with colposcopic examination.

Keywords

References

  1. NCI Workshop: The 1988 Bethesda System for reporting cervical/vaginal 'cytological diagnosis. JAMA 262:931-934, 1989
  2. Kurman RJ, Solomon D: The Bethesda System for Reporting Cervical/Vaginal Cytologic Diagnoses. New York, Springer-Verlag, 1994, pp30-34
  3. Sidawy MK, Tabbara SO: Reactive change and atypical squamous cells of undetermined significance in Papanicolaou smears: A cytohistologic correlation. Diagn Cytapathal 9:423-429,1993
  4. Howell LP, Davis RL: Follow-up of Papanicolaou smears diagnosed as atypical squamous cells of undetermined significance. Diagn Cytapathal 14:20-24,1996
  5. Williams ML, Rirnm DL, Pedigo MA, Frable WJ: Atypical squamous cells of undeterined significance: Correlative histologic and follow-up studies from an academic medical center. Diagn Cytapathal 16:1-7,1997
  6. Lachman MF, Cavallo-Calcanese C: Qualification of atypical squamous cells of undetermined significance in an independent laboratory: Is it useful or significant? Am J Obstet Gynecal 179:421-429,1998
  7. National Cancer Institute Workshop. The Bethesda system for reporting cervical/vaginal cytologic diagnoses:Report of the 1991 Bethesda Workshop. JAMA 267:1892,1992
  8. Kline MJ, Davey DD: Atypical squamous cells of undetermined significance qualified: A follow-up study. Diagn Cytopathol 14:380-384,1996
  9. Collins LC, Wang HH, Abu-Jawdeh AM: Qualifiers of atypical squamous cells of undetermined significance help in patient management. Mod Pathal 9:677-681,1996
  10. Vlahos NP, Dragisic KG, Wallach EE, Burroughs FH, Fluck S, Rosenthal DL: Clinical significance of the qualification of atypical squamous cells of undetermined significance: An analysis on the basis of histologic diagnoses. Am J Obstet Gynecal 182:885-890,2000 https://doi.org/10.1016/S0002-9378(00)70340-1
  11. Lee SS, Collins RJ, Pun TC, Cheng DK, Ngan HY: Conservative treatment of low grade squamous intraepithelial lesions (LSIL) of the cervix. Int J Gynecol Pathal 60:35-40,1998 https://doi.org/10.1016/S0020-7292(97)00219-1
  12. Falls RK: Spontaneous resolution rate of grade I cervical intraepithelial neoplasia in a private practice population. Am J Obstet Gynecol 181:278-282,1999
  13. Kinney WK, Manos MM, Hurley LB, Ransley JE: Where's the high-grade cervical neoplasia? The importance of minimally abnormal Papanicolaou diagnoses. Obstet Gynecal 91:973-976,1998
  14. Yang M, Zachariah S: ASCUS on cervical cytologic smears: Clinical significance. J ReprodMed 42:329-331,1997
  15. ChangChien CC, Lin H, Eng HL, Chang WK.: Clinical implication of atypical squamous cells of undetermined significance with or without favoring high-grade squamous intraepithelial lesion on cervical smear (abstract). Changgeng Yi Xue Za Ahi 22:579-585,1999
  16. Genest DR, Dean B, Lee KR, Sheets E, Crum CP, Cibas ES: Qualifying the cytologic diagnosis of 'atypical squamous cells of undetermined significance' affects the predictive value of a squamous intraepithelial lesion on subsequent biopsy. Arch Pathol Lab Med 122:338-341,1998
  17. Morin C, Bairati I, Bouchard C, et al.: Cytologic predictors of cervical intraepithelial neoplasia in women with an ASCUS pap smear. Acta Cytal 44:576-586,2000
  18. Sheils LA, Wilbur DC: Atypical squamous cells of undetermined significance: Stratification of the association with, or progression to, squamous intraepithelial lesions based on morphologic subcategorization. Acta Cytol 41: 1065-1072,1997
  19. Montes MA, Cibas ES, DiNixco SA, Lee KR: Cytologic characteristics of abnormal cells in prior 'normal' cervical/vaginal Papanicolaou smears from women with a high grade squamous intraepithelial lesion. Cancer 87:56-59,1999
  20. Sherman ME, Tabbara SO, Scott DR, et al.: 'ASCUS, R/O HSIL': Cytologic features, histologic correlates, and human papillomavirus detection. Mod Pathal 12:335-343,1999