Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion: cytohistologic correlation study with diagnostic pitfalls.
OBJECTIVE
In the current study, we explore the diagnostic parameters and pitfalls in the follow-up of 123 cases of Pap smears diagnosed as high-grade atypical squamous cells (ASC-H) at our institution.


METHODS
A computer database search was performed from the archives of the Ottawa Hospital Cytopathology Service for cases diagnosed with ASC-H between January 2003 and July 2005.


RESULTS
Follow-up of the 123 cases of ASC-H showed high grade squamous intraepithelial lesion (HSIL) in 73 patients (59.4%), low grade squamous intraepithelial lesion (LSIL) in 11 (8.9%), immature squamous metaplasia in 23 (18.7%), reactive squamous cell changes in 12 (9.8%), benign glandular lesions (endocervical atypia, degenerated glandular cells) in 2 (1.6%) and atrophy in 2 (1.6%). In our study, 83 patients were younger than 40 years (67.4%), with biopsy-proven HSIL found in 54 patients (65.1%). The remaining 40 patients (32.6%) were older than 40 years of age, and follow-up biopsies showed HSIL in 19 patients (47.5%).


CONCLUSIONS
In our study, 59.4% of the cases that were diagnosed cytologically as ASC-H were found to have HSIL on subsequent biopsies. This correlation was stronger in patients below the age of 40 years (65.1% vs. 47.5%). The cytopathologic feature most strongly associated with HSIL was the presence of coarse nuclear chromatin (84%).
Mokhtar
Ghadeer A
GA
Cytopathology Department, Division of Anatomic Pathology, The Ottawa Hospital, Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada.
Delatour
Nicolas L D Roustan
NL
Assiri
Ali H
AH
Gilliatt
M Angela
MA
Senterman
Mary
M
Islam
Shahidul
S
D000328:Adult; D000368:Aged; D001706:Biopsy; D002466:Cell Nucleolus / Q000473:pathology; D002584:Cervix Uteri / Q000473:pathology*; D002843:Chromatin / Q000473:pathology; D003127:Colposcopy; D003593:Cytoplasm / Q000473:pathology; D003951:Diagnostic Errors / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008679:Metaplasia; D008875:Middle Aged; D018307:Neoplasms, Squamous Cell / Q000145:classification / Q000235:genetics / Q000473:pathology*; D009864:Ontario; D065006:Papanicolaou Test; D009626:Terminology as Topic; D002583:Uterine Cervical Neoplasms / Q000145:classification / Q000235:genetics / Q000473:pathology*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000145:classification / Q000235:genetics / Q000473:pathology*
D002843:Chromatin