Atypical Squamous Cells of Undetermined Significance-Cannot Exclude High-Grade Squamous Intraepithelial Lesion: Histology Follow-Up and Clinical Correlation of 455 Cases
J Patel, J Zhou, A Khiyami, S Ganesan. MetroHealth Medical Center (CWRU), Cleveland, OH
Background: Atypical squamous cells of undetermined significance cannot exclude high-grade squamous intraepithelial lesion (ASC-H) is a relatively new diagnostic criteria and is suggestive of high-grade squamous intraepithelial lesion (HSIL) and its mimics. In general, ASC-H has a higher positive predictive value than Atypical Squamous Cells of undetermined significance (ASC-US). Pregnant, postpartum or postmenopausal women may have more parabasal cells on their pap smears. Could these parabasal cells cause higher ASC-H interpretation in this population? Do these patients have significant pathology in histological follow-up than the general population? The significance of ASC-H among pregnant, postpartum and postmenopausal populations has been unclear.
Design: A retrospective study was undertaken. The cytopathology files at MetroHealth Medical Center were searched for ASC-H cases from 1/1/2002-6/30/2007. 455 cases were diagnosed as ASC-H during this period. 74 patients were pregnant, 43 patients were postpartum, and 36 patients were postmenopausal. The histological follow-up was recorded and the high grade lesions included CIN II and CIN III. The results were analyzed with SPSS software.
Results: Of a total of 164,457 pap smears reviewed, 455(0.28%) cases were classified as ASC-H. 306 cases had histological follow-up. As a group, 35.9% of patients had HSIL in histological follow-up study, 30% of patients had CIN I, 1.6% had adenocarcinoma, and 32.3% had negative histology. The data was further analyzed by grouping the patients into pregnant, postpartum, postmenopausal and other (non-pregnant, non-postpartum, non-postmenopausal) categories. Postmenopausal women were found to have a significant reduction of high grade lesions in follow-up than the general population, 17.2% and 39.4% respectively (P=0.026). There was no significant difference between pregnant (30%) or postpartum (34.5%) populations compared to the general population (39.4%).
Conclusions: Our study included 455 patents with ASC-H, which compared to the literature, had the most study subjects. An interesting finding in our data was that postmenopausal women had a statistically significant decline in high grade cervical lesions. However, compared to the general population, pregnant and postpartum women do not seem to have a higher incidence of high grade cervical lesions on follow-up. Use of ancillary studies including HPV-DNA may be considered to further define ASC-H in postmenopausal population.
Wednesday, March 11, 2009 9:30 AM
Poster Session V # 35, Wednesday Morning