title: Smears diagnosed as ASCUS: interobserver variation and follow-up.
abstract: The purpose of this study was to apply atypical squamous cells of undetermined significance (ASCUS) criteria from the Bethesda System for Reporting Cervical/Vaginal Cytologic Diagnoses (TBS) to the rescreen of cases previously diagnosed as ASCUS, to compare initial and rescreen diagnoses, and to analyze agreement with follow-up (cytology or histology). Two cytotechnologists (S.B. and M.J.M.) and one cytopathology fellow (M.A.) rescreened 632 cervicovaginal specimens diagnosed as ASCUS between June 1, 1992-December 31, 1995. Age and LMP were provided. Rescreen diagnoses were categorized as within normal limits (WNL), ASCUS, low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), or carcinoma (CA). Complete agreement was found in 200 specimens (32%): 31 (15%) WNL; 91 (45%) ASCUS; 77 (38.5%) SIL; and one (0.50%) CA. Follow-up revealed no abnormality in 67% of the cases reclassified as WNL, 49% of the cases reclassified as ASCUS, and 48% of the cases reclassified as squamous intraepithelial lesions (SIL). SIL was found in 29% of cases reclassified as WNL, 29% of specimens rediagnosed as ASCUS, and 34% of cases reclassified as SIL. Partial agreement was found in 391 specimens (62%). In 41 specimens (6%), rescreeners were in complete disagreement, and follow-up revealed 9/41 (22%) SIL or worse; 21/41 (51%) WNL; and 4/41 (10%) inconclusive. Applying established criteria, 14% (91/632) of cases diagnosed as ASCUS resulted in complete agreement, and 30% (190/632) resulted in partial agreement. Follow-up of cases initially diagnosed as ASCUS revealed SIL or CA in 30% of cases. ASCUS is a significant diagnosis warranting careful patient follow-up.
authors.affiliation: Department of Cytology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. gatschar@mskcc.org
authors.forename: R M
authors.initials: RM
authors.lastname: Gatscha
authors.forename: M
authors.initials: M
authors.lastname: Abadi
authors.forename: S
authors.initials: S
authors.lastname: Babore
authors.forename: D
authors.initials: D
authors.lastname: Chhieng
authors.forename: M J
authors.initials: MJ
authors.lastname: Miller
authors.forename: P E
authors.initials: PE
authors.lastname: Saigo
mesh_terms: D005260:Female; D006801:Humans; D014621:Vagina / Q000473:pathology*; D014623:Vaginal Diseases / Q000473:pathology*; D014625:Vaginal Neoplasms / Q000473:pathology*; D014626:Vaginal Smears