title: Atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H): a result not to be ignored.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Alberta, Edmonton AB.
authors.forename: Drew
authors.initials: D
authors.lastname: Barreth
authors.affiliation: Department of Obstetrics and Gynaecology, University of Alberta, Edmonton AB.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Schepansky
authors.affiliation: Department of Obstetrics and Gynaecology, University of Alberta, Edmonton AB.
authors.forename: Valerie
authors.initials: V
authors.lastname: Capstick
authors.affiliation: Dynacare Kasper Medical Laboratories, Edmonton AB.
authors.forename: Gordon
authors.initials: G
authors.lastname: Johnson
authors.affiliation: Department of Obstetrics and Gynaecology, University of Alberta, Edmonton AB.
authors.forename: Helen
authors.initials: H
authors.lastname: Steed
authors.affiliation: Department of Obstetrics and Gynaecology, University of Alberta, Edmonton AB.
authors.forename: Wylam
authors.initials: W
authors.lastname: Faught
mesh_terms: 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