title: Nondiagnostic squamous atypia of the cervix (atypical squamous epithelium of undetermined significance): histologic and molecular correlates.
abstract: The histologic criteria for reactive/reparative lesions and precursor lesions (squamous intraepithelial lesions; SIL) of the cervix are established, but a proportion of cervical biopsies contains squamous epithelial alterations that do not fall into either category (nondiagnostic squamous atypia or atypical squamous epithelium of undetermined significance). This study examined (a) the degree to which this diagnosis could be made consistently between two experienced pathologists and (b) its relationship to papillomavirus nucleic acids. One author selected 37 cervical biopsies with a spectrum of cellular changes occurring in the context of inflammatory or reactive epithelial changes, and each case was reviewed by two pathologists independently and classified as reactive, nondiagnostic atypia, and diagnostic (SIL). Concordance between two observers was highest for a diagnosis of SIL (kappa = 0.68), followed by reparative/reactive (kappa = 0.48). Concordance for a designation as nondiagnostic squamous atypia was fair (kappa = 0.39). Seven of 37 (19%) cases were HPV positive, including 2/7, 5/19, and 0/11 cases designated by at least one observer as SIL, nondiagnostic squamous atypia, or neither (i.e., both reactive), respectively. The findings support a category of nondiagnostic squamous atypia but emphasize the value of a second observer and possibly, HPV DNA testing, in resolving such cases. Similarities in HPV positivity between nondiagnostic atypia and SIL in this study may reflect problems of both criteria selection and consistent application of these criteria in a setting of reactive/reparative changes.
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts 02115.
authors.forename: C J
authors.initials: CJ
authors.lastname: Prasad
authors.forename: D R
authors.initials: DR
authors.lastname: Genest
authors.forename: C P
authors.initials: CP
authors.lastname: Crum
mesh_terms: D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D015588:Observer Variation; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000473:pathology; D011230:Precancerous Conditions / Q000473:pathology* / Q000821:virology; D014412:Tumor Virus Infections / Q000473:pathology; D002578:Uterine Cervical Dysplasia / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000821:virology; D014626:Vaginal Smears
chemical_list: D004279:DNA, Viral