title: Cervical cytology with a diagnosis of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H): a follow-up study with corresponding histology and significance of predicting dysplasia by human papillomavirus (HPV) DNA testing.
abstract: OBJECTIVE
  To evaluate the clinical significance of "atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion" ASC-H by comparing the original cytologic findings with follow-up tissue biopsies, and its association with high-risk HPV.
  
  
  METHODS
  A total of 235,518 ThinPrep Pap tests were performed at our institution from January 2008 through December 2010, but only 727 (0.3%) of these cases were diagnosed as ASC-H.
  
  
  RESULTS
  Of the 309 cases diagnosed as ASC-H on cytology for which follow-up histologic material was available, 120 (38.8%) were definitively diagnosed as high-grade dysplasia (CIN 2/3) and 75 (24.2%) showed features of low-grade dysplasia (CIN 1). We observed that the incidence of dysplasia in patients less than 30 years of age was 73.4% (113/154) and 48.3% (14/29) in patients greater than 49 years of age (p = 0.001). There were 71 cases for which high-risk HPV DNA testing was conducted. HPV DNA was found to be positive in 41 of the dysplastic cases (CIN 1 = 18 cases and CIN 2/3 = 23) and negative in six of the dysplastic cases (CIN1 = 2 and CIN2/3 = 4).
  
  
  CONCLUSIONS
  We conclude that cases diagnosed as ASC-H should be followed-up with caution as they are strongly associated with dysplasia of any grade (63.1%), especially high-grade dysplasia (38.8%). Reflex HPV DNA testing is an important predictor of dysplasia with a positive predictive value of 87.2% in our study.
authors.affiliation: Department of Pathology, St. John Hospital and Medical Center, 22101 Moross Road, CCB-SB, Detroit, MI, 48236, USA, magilani@hotmail.com.
authors.forename: Syed M
authors.initials: SM
authors.lastname: Gilani
authors.forename: Randy
authors.initials: R
authors.lastname: Tashjian
authors.forename: Lamia
authors.initials: L
authors.lastname: Fathallah
mesh_terms: D000328:Adult; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D061809:Human Papillomavirus DNA Tests; D006801:Humans; D008875:Middle Aged; D018307:Neoplasms, Squamous Cell / Q000473:pathology* / Q000821:virology; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000821:virology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000821:virology / Q000473:pathology*; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000821:virology; D014626:Vaginal Smears