Atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H): a result not to be ignored.
OBJECTIVE
The objective of this study was to determine the risk of a clinically significant lesion associated with the diagnosis of atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H) on cervical cytology (Pap smear).


METHODS
This was a retrospective, observational, descriptive study. A computerized database containing cytologic and histologic information for the health region was used to identify women with a diagnosis of ASC-H on a Pap smear performed between January 1 and December 31, 2002. All pertinent pathology data (cytopathology, histopathology, and surgical specimens) were examined. Patients were excluded if they had a diagnosis of cervical cancer, adenocarcinoma in situ (AIS), or high-grade squamous intraepithelial lesion (HSIL) prior to the index Pap smear.


RESULTS
During the study period, 727 of 241 841 Pap smears (0.3%) were reported as ASC-H in 655 patients. Ninety-one patients had a previous diagnosis of cervical cancer, AIS, or HSIL and were excluded from analysis, and 12 patients on review did not have ASC-H. There were no follow-up data for 35 of the remaining 552 patients, leaving 517 patients in the study group. In this group, the rates of histologically proven cervical lesions were 2.9% (15/517) for cervical cancer, 1.7% (9/517) for AIS, and 65.6% (339/517) for HSIL. Women undergoing a procedure that included histological examination were more likely to have a significant lesion discovered.


CONCLUSIONS
The diagnosis of ASC-H on Pap smear is associated with an appreciable risk of clinically significant disease. Patients with an ASC-H Pap smear result should undergo timely colposcopic and histologic assessment to rule out HSIL, AIS, and cervical cancer.
Barreth
Drew
D
Department of Obstetrics and Gynaecology, University of Alberta, Edmonton AB.
Schepansky
Alexandra
A
Department of Obstetrics and Gynaecology, University of Alberta, Edmonton AB.
Capstick
Valerie
V
Department of Obstetrics and Gynaecology, University of Alberta, Edmonton AB.
Johnson
Gordon
G
Dynacare Kasper Medical Laboratories, Edmonton AB.
Steed
Helen
H
Department of Obstetrics and Gynaecology, University of Alberta, Edmonton AB.
Faught
Wylam
W
Department of Obstetrics and Gynaecology, University of Alberta, Edmonton AB.
D000328:Adult; D000367:Age Factors; D003127:Colposcopy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D018307:Neoplasms, Squamous Cell / Q000175:diagnosis* / Q000473:pathology; D065006:Papanicolaou Test; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000473:pathology; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology