title: Do qualifiers of ASCUS distinguish between low- and high-risk patients?
abstract: OBJECTIVE
  To evaluate the qualification of a Pap smear classified as atypical squamous cells of undetermined significance (ASCUS) favor reactive or neoplasia as recommended by the Bethesda System.
  
  
  METHODS
  The smears from 105 concurrent patients with a cytologic diagnosis of ASCUS not otherwise qualified were reviewed and subclassified as ASCUS favor reactive, low grade squamous intraepithelial lesion (LSIL) or high grade squamous intraepithelial lesion (HSIL) based on the Bethesda System criteria. The cervical biopsy diagnoses were correlated.
  
  
  RESULTS
  Of the 105 cases classified as ASCUS, 37 were subclassified as favor reactive, 51 as favor LSIL and 17 as favor HSIL on cytologic review. In the ASCUS favor reactive group, 19 (51%) had reactive changes on biopsy, 17 (46%) had cervical intraepithelial neoplasia (CIN) 1, and 1 (2%) had CIN 3. A total of 48% patients had CIN. In the favor LSIL group, there was CIN 1 in 28 cases (55%), CIN 2 or 3 in 12 (23%) and benign changes in 11 (22%) on biopsy. Seventy-eight percent had CIN. In the 17 cases classified as ASCUS favor HSIL group, all had CIN.
  
  
  CONCLUSIONS
  Of the total 105 cases of ASCUS, 71% had CIN, 29% had reactive changes on follow-up biopsies, and 48% of patients in the ASCUS favor reactive group had CIN. Qualifiers of ASCUS have questionable utility in patient management.
authors.affiliation: Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville 32610, USA.
authors.forename: S N
authors.initials: SN
authors.lastname: Malik
authors.forename: E J
authors.initials: EJ
authors.lastname: Wilkinson
authors.forename: P A
authors.initials: PA
authors.lastname: Drew
authors.forename: B B
authors.initials: BB
authors.lastname: Bennett
authors.forename: N S
authors.initials: NS
authors.lastname: Hardt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002278:Carcinoma in Situ / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D002578:Uterine Cervical Dysplasia / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D014626:Vaginal Smears