title: Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion: review of ancillary testing modalities and implications for follow-up.
abstract: OBJECTIVE
  To review the cytology category atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H), with human papillomavirus (HPV) and other ancillary testing results and according to age group.
  
  
  METHODS
  A literature search was performed on the ASC-H category, and studies analyzing ASC-H according to ancillary testing modalities or patient age groups during the past 4 years were emphasized.
  
  
  RESULTS
  The ASC-H category accounts for less than 1% of cytology reports, and 33% to 84% will test positive for oncogenic HPV. The number of patients with cervical intraepithelial neoplasia 2/3 and cancer on biopsy is quite variable, from about 12% to more than 70%, averaging about 40%. The variation reflects patient population as well as local laboratory practices, but older subgroups are more likely to have negative HPV results and negative follow-up. Both the sensitivity of HPV testing for cervical intraepithelial neoplasia 2/3 detection and the negative predictive value for a patient with ASC-H and negative HPV testing average more than 95%. Additional studies evaluating other types of ancillary testing for the ASC-H category are needed.
  
  
  CONCLUSIONS
  Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion, is an uncommon cytology result, and HPV testing results and biopsy follow-up show variation according to patient age group and local laboratory practices. A negative HPV result in ASC-H offers a high negative predictive value and could be considered as a management strategy in mature women as well as women 30 years and older receiving combined cytology and HPV screening.
authors.affiliation: Department of Medical Education, University of Central Florida College of Medicine, Orlando, FL 32816-0116, USA. ddavey@mail.ucf.edu
authors.forename: Diane Davis
authors.initials: DD
authors.lastname: Davey
authors.forename: David L
authors.initials: DL
authors.lastname: Greenspan
authors.forename: Daniel F I
authors.initials: DF
authors.lastname: Kurtycz
authors.forename: Mujtaba
authors.initials: M
authors.lastname: Husain
authors.forename: R Marshall
authors.initials: RM
authors.lastname: Austin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002584:Cervix Uteri / Q000166:cytology* / Q000473:pathology / Q000821:virology*; D002648:Child; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis*; D011237:Predictive Value of Tests; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*