title: Underlying pathology of women with "atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion" smears, in a region with a high incidence of cervical cancer.
abstract: OBJECTIVE
  To evaluate the histopathology of women who had "atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions" (ASC-H) on cervical cytology in a region with high incidence of cervical cancer.
  
  
  METHODS
  This study was conducted at Chiang Mai University Hospital, Chiang Mai, Thailand. All women with ASC-H, who had undergone colposcopic and histolopathologic evaluation between October 2004 and January 2007, were recruited. Similar cohorts with other squamous cell abnormalities on a Pap-smear, who had undergone colposcopy during the same period, were included as comparative groups.
  
  
  RESULTS
  During the study period, 85 women who had ASC-H smears underwent colposcopic and histopathologic evaluation. The mean age was 45.3 years (range, 20-64 years). The histopathologic results of these 85 women were as follows: cervical intraepithelial neoplasia (CIN) II-III, 52 (61.2%); invasive cancer, 7 (8.2%); CIN I, 6 (7.1%); and no lesions, 20 (23.5%). The incidence of underlying CIN II or higher in an ASC-H smear (69.4%) was intermediate between atypical squamous cell of undetermined significance (22.7%), low-grade squamous intraepithelial lesion (44.7%) and high-grade squamous intraepithelial lesion (90.5%) smears. There was no statistically significant difference in the incidence of CIN II or higher between women who were 40 years old or more and those who were younger (68.7% and 71.4%, respectively, P=0.81), or between pre-menopausal and post-menopausal women (71.4% and 63.6%, respectively, P=0.49).
  
  
  CONCLUSIONS
  Reporting ASC-H cytology in our population is strongly associated with significant cervical pathology, particularly invasive cancer that is possibly at a rate higher than previously reported. Women who have ASC-H smears should therefore be referred for immediate colposcopy regardless of age and menopausal status.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. kiet_ji@hotmail.com
authors.forename: Chumnan
authors.initials: C
authors.lastname: Kietpeerakool
authors.forename: Jatupol
authors.initials: J
authors.lastname: Srisomboon
authors.forename: Charuwan
authors.initials: C
authors.lastname: Tantipalakorn
authors.forename: Prapaporn
authors.initials: P
authors.lastname: Suprasert
authors.forename: Surapan
authors.initials: S
authors.lastname: Khunamornpong
authors.forename: Kanchana
authors.initials: K
authors.lastname: Nimmanhaeminda
authors.forename: Sumalee
authors.initials: S
authors.lastname: Siriaunkgul
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003127:Colposcopy; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D008875:Middle Aged; D018307:Neoplasms, Squamous Cell / Q000473:pathology*; D065006:Papanicolaou Test; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology*