title: Where's the high-grade cervical neoplasia? The importance of minimally abnormal Papanicolaou diagnoses.
abstract: OBJECTIVE
  To characterize the relative contributions of the different abnormal Papanicolaou smear cytologic diagnoses in the Bethesda System to the subsequent histologic diagnosis of high-grade cervical neoplasia.
  
  
  METHODS
  A total of 46,009 nonpregnant female members of the Kaiser Permanente Health Plan, Northern California Region, were studied prospectively. The main outcome measures included routine Papanicolaou smear diagnoses and subsequent histologic diagnosis of colposcopically directed cervical tissue specimens.
  
  
  RESULTS
  Atypical squamous cells of undetermined significance (ASCUS) was the most common abnormal Papanicolaou diagnosis, representing 3.6% of the total number of smears. Of the total number of cases of histologically confirmed high-grade cervical neoplasia present in the population, the largest proportion (38.8%) was in women with smears showing ASCUS. Minimal abnormalities combined (ASCUS, atypical glandular cells of undetermined significance, and low-grade squamous intraepithelial lesion) were coincident with 68.6% of the cases of histologic high-grade cervical neoplasia diagnosed in this routine screening population.
  
  
  CONCLUSIONS
  Recognition of the importance of equivocal and mild Papanicolaou test abnormalities in the subsequent diagnosis of high-grade cervical neoplasia emphasizes the need for accurate and cost-effective triage of the large population of women with minimally abnormal Papanicolaou diagnoses.
authors.affiliation: Department of Pathology (South San Francisco), Kaiser Permanente Medical Group of Northern California, USA.
authors.forename: W K
authors.initials: WK
authors.lastname: Kinney
authors.forename: M M
authors.initials: MM
authors.lastname: Manos
authors.forename: L B
authors.initials: LB
authors.lastname: Hurley
authors.forename: J E
authors.initials: JE
authors.lastname: Ransley
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology; D000328:Adult; D017677:Age Distribution; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D065006:Papanicolaou Test; D011237:Predictive Value of Tests; D011446:Prospective Studies; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology*; D014626:Vaginal Smears / Q000145:classification / Q000706:statistics & numerical data