title: Prevalence of cervical intraepithelial neoplasia grades II/III and cervical cancer in patients with cytological diagnosis of atypical squamous cells when high-grade intraepithelial lesions (ASC-H) cannot be ruled out.
abstract: OBJECTIVE
  The latest update of the Bethesda System divided the category of atypical squamous cells of undetermined significance (ASCUS) into ASC-US (undetermined significance) and ASC-H (high-grade intraepithelial lesion cannot be ruled out). The aims here were to measure the prevalence of pre-invasive lesions (cervical intraepithelial neoplasia, CIN II/III) and cervical cancer among patients referred to Instituto Fernandes Figueira (IFF) with ASC-H cytology, and compare them with ASC-US cases.
  
  
  METHODS
  Cross-sectional study with retrospective data collection, at the IFF Cervical Pathology outpatient clinic.
  
  
  METHODS
  ASCUS cases referred to IFF from November 1997 to September 2007 were reviewed according to the 2001 Bethesda System to reach cytological consensus. The resulting ASC-H and ASC-US cases, along with new cases, were analyzed relative to the outcome of interest. The histological diagnosis (or cytocolposcopic follow-up in cases without such diagnosis) was taken as the gold standard.
  
  
  RESULTS
  The prevalence of CIN II/III in cases with ASC-H cytology was 19.29% (95% confidence interval, CI, 9.05-29.55%) and the risk of these lesions was greater among patients with ASC-H than with ASC-US cytology (prevalence ratio, PR, 10.42; 95% CI, 2.39-45.47; P = 0.0000764). Pre-invasive lesions were more frequently found in patients under 50 years of age with ASC-H cytology (PR, 2.67; 95% CI, 0.38-18.83); P = 0.2786998). There were no uterine cervical cancer cases.
  
  
  CONCLUSIONS
  The prevalence of CIN II/III in patients with ASC-H cytology was significantly higher than with ASC-US, and division into ASC diagnostic subcategories had good capacity for discriminating the presence of pre-invasive lesions.
authors.affiliation: Hospital Geral de Ipanema, Rio de Janeiro, Brazil. andreacytryn@hotmail.com
authors.forename: Andréa
authors.initials: A
authors.lastname: Cytryn
authors.forename: Fábio Bastos
authors.initials: FB
authors.lastname: Russomano
authors.forename: Maria José de
authors.initials: MJ
authors.lastname: Camargo
authors.forename: Lucília Maria Gama
authors.initials: LM
authors.lastname: Zardo
authors.forename: Nilza Maria Sobral Rebelo
authors.initials: NM
authors.lastname: Horta
authors.forename: Rachel de Carvalho Silveira de Paula
authors.initials: Rde C
authors.lastname: Fonseca
authors.forename: Maria Aparecida
authors.initials: MA
authors.lastname: Tristão
authors.forename: Aparecida Cristina Sampaio
authors.initials: AC
authors.lastname: Monteiro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D018307:Neoplasms, Squamous Cell / Q000453:epidemiology* / Q000473:pathology; D015995:Prevalence; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000473:pathology