Clinical implications of the diagnosis "atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion" in pregnant women.
BACKGROUND
Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) has a high predictive value for high-grade intraepithelial lesion (HSIL) in the general population. However, the significance of ASC-H in pregnant women remains to be elucidated. The objective of this study was to investigate the clinical implications and pathologic significance of ASC-H in pregnant women, so that these patients will be managed appropriately.


METHODS
All Papanicolaou tests that were diagnosed as ASC-H in pregnant women over 1.5 years (total, 60 women) were reviewed and correlated with histologic and/or cytologic follow-up. High-risk type of human papillomavirus (HPV) status was also correlated with follow-up findings. The following cytomorphologic parameters were evaluated for each woman and were compared between the squamous intraepithelial lesion (SIL) follow-up group and the benign follow-up group: inflammatory background, the number of atypical cells, cell arrangement pattern, nuclear irregularity/grooves, hyperchromasia, and cell shape.


RESULTS
Among 30 women who had histologic follow-up, 3 women (10%) had HSIL, and 13 women (43%) had low-grade intraepithelial lesion (LSIL). Among 32 women who had cytologic follow-up, 2 women (6%) had HSIL, 3 women (9%) had LSIL, 1 woman (3%) had ASC-H, and 3 women (9%) had atypical squamous cells of undetermined significance (ASCUS). HPV was detected in 24 of 43 women (56%). The cytomorphologic features were similar in the SIL follow-up group and the benign follow-up group. No specific cytomorphologic features that predicted underlying SIL were identified.


CONCLUSIONS
ASC-H in pregnant women had a lower predictive value for an underlying HSIL compared with the general population. A positive HPV test result was not a good indicator for an underlying SIL, but a negative result appeared to be useful for ruling out an underlying HSIL. Because of low positive predictive value for HSIL and the difficult colposcopic examination, a more conservative follow-up may be reasonable for pregnant women who have a diagnosis of ASC-H. HPV testing may be used as an adjunctive test.
Onuma
Kazuya
K
Department of Pathology, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. kzyonm@nifty.com
Saad
Reda S
RS
Kanbour-Shakir
Amal
A
Kanbour
Anisa I
AI
Dabbs
David J
DJ
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D018307:Neoplasms, Squamous Cell / Q000473:pathology* / Q000821:virology; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000473:pathology* / Q000821:virology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000473:pathology* / Q000821:virology; D012307:Risk Factors; D014412:Tumor Virus Infections / Q000150:complications / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000821:virology