Atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H): a result not to be ignored.

OBJECTIVE: The objective of this study was to determine the risk of a clinically significant lesion associated with the diagnosis of atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H) on cervical cytology (Pap smear). METHODS: This was a retrospective, observational, descriptive study. A computerized database containing cytologic and histologic information for the health region was used to identify women with a diagnosis of ASC-H on a Pap smear performed between January 1 and December 31, 2002. All pertinent pathology data (cytopathology, histopathology, and surgical specimens) were examined. Patients were excluded if they had a diagnosis of cervical cancer, adenocarcinoma in situ (AIS), or high-grade squamous intraepithelial lesion (HSIL) prior to the index Pap smear. RESULTS: During the study period, 727 of 241 841 Pap smears (0.3%) were reported as ASC-H in 655 patients. Ninety-one patients had a previous diagnosis of cervical cancer, AIS, or HSIL and were excluded from analysis, and 12 patients on review did not have ASC-H. There were no follow-up data for 35 of the remaining 552 patients, leaving 517 patients in the study group. In this group, the rates of histologically proven cervical lesions were 2.9% (15/517) for cervical cancer, 1.7% (9/517) for AIS, and 65.6% (339/517) for HSIL. Women undergoing a procedure that included histological examination were more likely to have a significant lesion discovered. CONCLUSION: The diagnosis of ASC-H on Pap smear is associated with an appreciable risk of clinically significant disease. Patients with an ASC-H Pap smear result should undergo timely colposcopic and histologic assessment to rule out HSIL, AIS, and cervical cancer.

The relationship between atypical glandular cells of undetermined significance on Pap smear and a clinically significant histologic diagnosis.

OBJECTIVE: To determine whether the cytologic diagnosis of atypical glandular cells of undetermined significance (AGUS) on Pap smear was associated with a clinically significant histologic diagnosis. METHODS: A retrospective cohort study was performed on the charts of women diagnosed with AGUS on Pap smear in 2 referral colposcopy clinics, between January 1999 and July 2002. The factors considered included age, menstrual status, use of birth control pills or hormone replacement therapy, parity, referral Pap, type of evaluation at colposcopy, histologic diagnosis, and final diagnosis at pathology. RESULTS: Of the 124 women with a referral diagnosis of AGUS, 41 (33.1%) had significant histology at colposcopy. Premenopausal and nulliparous women were more likely to have a significant histologic diagnosis. The categories of "favour neoplastic" and "favour reactive" were not predictive of significant histology. Menopausal status was not predictive of either endometrial or endocervical disease among serious lesions. CONCLUSIONS: Because almost one-third of women with the finding of AGUS on Pap smear will have a diagnosis at the time of colposcopy that requires treatment, a colposcopy and endocervical curettage should be recommended to all women with AGUS. The new designation of "atypical glandular cells" (AGC) under the 2001 Bethesda classification system is appropriate, as "favour reactive" and "favour neoplastic" are not predictive of serious histologic findings.