Atypical Squamous Cells, Cannot Exclude High-Grade Squamous Intraepithelial Lesion: Review of Ancillary Testing Modalities and Implications for Follow-up

    Authors

    D. D. Davey; D. L. Greenspan; D. F. I. Kurtycz; M. Husain;R. M. Austin

    Comments

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    Abbreviated Journal Title

    J. Low. Genit. Tract. Dis.

    Keywords

    atypical squamous cells; cannot exclude high grade squamous; intraepithelial lesion; ASC-H; Pap test; human papillomavirus; cervical; cytology; ASC-H; CERVICAL CYTOLOGY; CLINICAL-SIGNIFICANCE; COMPARISON PROGRAM; REPORTING RATES; WOMEN; TERMINOLOGY; P16(INK4A); TRIAGE; POSTMENOPAUSAL; Obstetrics & Gynecology

    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.

    Journal Title

    Journal of Lower Genital Tract Disease

    Volume

    14

    Issue/Number

    3

    Publication Date

    1-1-2010

    Document Type

    Review

    Language

    English

    First Page

    206

    Last Page

    214

    WOS Identifier

    WOS:000279383900010

    ISSN

    1089-2591

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