Atypical squamous cells of undetermined significance: is it worthwhile to qualify them further?
BACKGROUND
In Bethesda System of reporting cervico-vaginal smears, the equivocal epithelial cell abnormalities have been categorised as "atypical squamous and glandular cells of undetermined significance" (ASCUS and AGUS). These abnormalities may harbour minor lesions attributed to mere inflammatory changes to potentially serious high grade lesions. It is recommended to further qualify these lesions according to whether they favor a reactive or a neoplastic outcome.


OBJECTIVE
We undertook the present study to assess the significance of ASCUS qualifiers.


METHODS
A total of 12071 women were screened for early detection of cancer cervix. The women with ASCUS diagnosis were further qualified as ASCUS favor reactive and ASCUS favor SIL (Squamous intraepithelial lesion) according the Bethesda 1991 system of reporting. ASCUS-reactive cases were followed up by a repeat smear examination and persistent ASCUS cases were taken up for colposcopy and biopsy if indicated. All ASCUS-SIL cases were taken up for immediate colposcopy.


RESULTS
The pick up rate of high grade lesions was not significantly different (P=0.47; Chi square test) on the follow up of ASCUS-reactive (2/222) and ASCUS-SIL (2/130) groups. The low grade lesions were picked up in 10/222 ASCUS-reactive and 58/130 in ASCUS-SIL, which was statistically significant (P < 0.001).


CONCLUSIONS
The results of our study indicate that it is not worthwhile to qualify these lesions as majority of ASCUS-SIL also revealed only low grade epithelial which have a benign biological behaviour.
Sodhani
P
P
Department of Cytopathology, Institute of Cytology and Preventive Oncology (ICMR), Maulana Azad Medical College Campus, New Delhi-110 002, India. psodhani@yahoo.com
Gupta
S
S
Sehgal
A
A
Singh
V
V
Khan
I U
IU
Mitra
A B
AB
D000328:Adult; D002584:Cervix Uteri / Q000473:pathology*; D003663:Decision Trees; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008499:Medical Records; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology* / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology* / Q000821:virology