Low-grade pap smears containing occasional high-grade cells as a predictor of high-grade dysplasia.
OBJECTIVE
This study compared clinical outcomes associated with Pap smear reports of atypical squamous cells cannot exclude HSIL (ASC-H) and those associated with "low-grade smears containing occasional cells suggestive of HSIL" (LSIL-H). In Alberta, women with ASC-H are referred for colposcopy, and women with LSIL are managed with follow-up Pap smears. LSIL-H is not included in the Bethesda classification and has not been characterized in terms of cytological features, reporting, management, and clinical course.


METHODS
All ASC-H (n = 153) and LSIL-H (n = 189) Pap smears recorded in the regional laboratory information system between December 2000 and December 2001 were identified. All available histology for each associated patient over the subsequent two&year period was reviewed to determine if a high-grade histological lesion was ever confirmed in a biopsy, loop electrosurgical excision procedure (LEEP), or hysterectomy specimen.


RESULTS
A high-grade squamous intraepithelial lesion was identified in 48% of the ASC-H group and 40% of the LSIL-H group (P = 0.136). Most of the HSIL histopathology was identified on the first colposcopic visit, suggesting that high-grade dysplasia may have been present at the time of the original Pap smear.


CONCLUSIONS
Pap smears reporting ASC-H and LSIL-H predict a high-grade squamous intraepithelial lesion with similar accuracy. Since approximately 40% of patients with an LSIL-H Pap smear have either concurrent or subsequent high-grade cervical pathology, we also recommend immediate referral for colposcopy in this group of patients.
Power
Patti
P
Newfoundland Cancer and Treatment Research Foundation, St. John's NL.
Gregoire
Jean
J
Gynecologic Oncology Service, Centre Hospitalier Universitaire de Québec, Quebec City QC.
Duggan
Máire
M
Department of Pathology and Laboratory Medicine, Foothills Hospital, Calgary AB.
Nation
Jill
J
Department of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary AB.
D000293:Adolescent; D000328:Adult; D000368:Aged; D003127:Colposcopy; 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 / Q000592:standards*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology