title: Comparison of the clinical significance of the Papanicolaou test interpretations LSIL cannot rule out HSIL and ASC-H.
abstract: Despite the two-tiered classification of dysplasia in The Bethesda System (TBS), rare cases fall into the category squamous intraepithelial lesion (SIL) of indeterminate grade. These Pap tests are often interpreted as "LSIL/ASC-H" or "LSIL" with a comment indicating the presence of cells with features approaching HSIL. Patients with LSIL/ASC-H have a significant risk of CIN 2 or worse (29-61.5%) on follow-up cervical biopsies, similar to the risk of CIN 2 or worse in patients with ASC-H Pap tests (24-68%). The purpose of this study was to compare patients with ASC-H and LSIL/ASC-H Pap tests. Women with LSIL/ASC-H had a slightly lower incidence of CIN 2 or worse (PPV = 35.6%, 95% CI: 29.8-41.4%) on follow-up cervical biopsy than the control ASC-H group (PPV = 40.2%, 95% CI: 31.9-56.3%); this difference was not statistically significant. The difference in the distribution of the biopsy results between the two groups was statistically significant (P < 0.001). The current guidelines for the management of cervical cytologic abnormalities from the American Society for Colposcopy and Cervical Pathology (ASCCP) advocate similar treatment algorithms for both LSIL and ASC-H. The main difference is the option of cytologic follow-up or HPV testing for certain "special populations," as an alternative to colposcopy, for LSIL Pap test results. Based on our results, we recommend (1)LSIL/ASC-H to be added to TBS classification and (2) Pap test cases of LSIL/ASC-H may need to be clinically followed in a manner similar to ASC-H, i.e., colposcopy for all patients.
authors.affiliation: Department of Pathology and Area Laboratory Services, Brooke Army Medical Center, Fort Sam Houston, Texas, USA. pathqueen@hotmail.com
authors.forename: Megan J
authors.initials: MJ
authors.lastname: Difurio
authors.forename: Thomas
authors.initials: T
authors.lastname: Mailhiot
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sundborg
authors.forename: Karen K
authors.initials: KK
authors.lastname: Nauschuetz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D018307:Neoplasms, Squamous Cell / Q000175:diagnosis* / Q000473:pathology; D065006:Papanicolaou Test; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014626:Vaginal Smears / Q000379:methods*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology