title: Atypical squamous cells of undetermined significance in the pediatric population. Implications for management and comparison with the adult population.
abstract: OBJECTIVE
  To determine the significance of an atypical squamous cells of undetermined significance (ASCUS) diagnosis in patients 18 years or younger.
  
  
  METHODS
  From June 1994 to June 1995, 630 cervicovaginal smears were performed on patients 18 years or younger (mean age 16.4, range 14-18) at University Hospitals of Cleveland. Of these patients, 69 (10.9%) were diagnosed with ASCUS or ASCUS with a qualifying statement. Follow-up cervicovaginal smears, biopsies and charts were reviewed for a 12-18-month period following the initial diagnosis of ASCUS.
  
  
  RESULTS
  The study population was sexually active: 63% were gravid, 21% were multigravid, 68% had a history of sexually transmitted diseases (STDs), and 32% had multiple STDs. Follow-up cervicovaginal smears or biopsies were obtained on 46 patients (32 cervicovaginal smears and 14 biopsies/endocervical curettage cases). Mild to moderate dysplasia was identified in 21.6% of patients (10.8% on cervicovaginal smears and 10.8% on biopsies), and a repeat diagnosis of ASCUS was given in 37%. In patients with a repeat diagnosis of ASCUS, a follow-up cervicovaginal smear or biopsy revealed dysplasia in an additional 13%. The overall rate of dysplasia was 34.7%.
  
  
  CONCLUSIONS
  Regardless of age, the diagnosis of ASCUS in a sexually active patient population has significant implications. Furthermore, we recommend that these patients be managed the same way as high-risk adult patients.
authors.affiliation: Department of Pathology, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Ohio, USA.
authors.forename: A E
authors.initials: AE
authors.lastname: Rader
authors.forename: R
authors.initials: R
authors.lastname: Lazebnik
authors.forename: C D
authors.initials: CD
authors.lastname: Arora
authors.forename: J
authors.initials: J
authors.lastname: Franklin
authors.forename: F W
authors.initials: FW
authors.lastname: Abdul-Karim
mesh_terms: D000293:Adolescent; D000328:Adult; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000628:therapy; D014626:Vaginal Smears