title: Clinical Relevance of ASC-H Cytologies: Experience in a Single Tertiary Hospital.
abstract: OBJECTIVE
  To review the cases of atypical squamous cells (ASC), cannot exclude squamous intraepithelial lesion (ASC-H) diagnosed at a single institution and to discuss the interpretation challenges and clinical management of these cases.
  
  
  METHODS
  The ASC-H cases diagnosed at our institution from 2006 to 2015 were studied retrospectively; of 159,000 Pap smears, there were 959 cases of ASC of undetermined significance (ASC-US) and 148 cases of ASC-H. We have reviewed the clinical records of the ASC-H cases, and data have been analyzed using SPSS 20.0.
  
  
  RESULTS
  Median age was 43.1 years; 49.6% of the patients had previous cervical cytologies, and 55.9% of them were negative. Following ASC-H diagnosis, another smear was obtained in 97.1% of the cases and in 67.6% a biopsy was performed. Biopsy revealed low-grade dysplasia in 18.8% of the cases, high-grade dysplasia in 27.8%, and infiltrating carcinoma in 2.3%. Patients with significant lesions in histology were younger than patients with negative results (p = 0.08). A diagnosis of ASC-H/squamous intraepithelial lesion in the repeated cytology had a sensitivity of 74.2%, specificity of 39.6%, positive predictive value of 44.8%, and negative predictive value of 70% for the diagnosis of dysplasia.
  
  
  CONCLUSIONS
  ASC-H diagnosis is associated with a high incidence of histological high-grade lesions. A repeat cytology can aid in the selection of high-risk patients, but there may be false-negative results.
authors.affiliation: Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Díaz Del Arco
authors.forename: M Carmen
authors.initials: MC
authors.lastname: Sanabria Montoro
authors.forename: Dolores
authors.initials: D
authors.lastname: García López
authors.forename: Eva
authors.initials: E
authors.lastname: Rodríguez Escudero
authors.forename: M Jesús
authors.initials: MJ
authors.lastname: Fernández Aceñero
mesh_terms: D000328:Adult; D065309:Atypical Squamous Cells of the Cervix / Q000473:pathology*; D001706:Biopsy / Q000379:methods; D003127:Colposcopy / Q000379:methods; D005260:Female; D006801:Humans; D065006:Papanicolaou Test / Q000379:methods; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D014626:Vaginal Smears / Q000379:methods; D002578:Uterine Cervical Dysplasia / Q000473:pathology*