[385] Incidence and Clinical Outcome of Pregnant Women Diagnosed with ASC-H or HSIL on Antepartum Pap Test.

Suneal Jannapureddy, George Birdsong, Marina Mosunjac, Talaat Tadros, Krisztina Hanley. Emory University School of Medicine, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA

Background: According to the 2006 consensus guidelines, management of pregnant women with atypical squamous cells cannot exclude high grade dysplasia (ASC-H) or high grade squamous intraepithelial lesion (HSIL) is determined by the initial colposcopy result. The focus of our study is to examine the incidence and clinical outcome of pregnant patients diagnosed with ASC-H or HSIL on antepartum Pap smear in a high-risk patient population.
Design: We conducted a retrospective review of cervical cytology results in pregnant patients from a large inner-city hospital with a high-risk population from July 2006 to December 2009. Patients were included in the study based on concurrent placenta confirming an underlying pregnancy. Postpartum cytology (cervical smear) and/or surgical pathology results (biopsy or excision) were reviewed.
Results: A total of 2791 patients with antepartum cervical cytology results were identified. Squamous cell abnormality was present in 707 (25.4%), including 341 (12.2%) of atypical squamous cells of undetermined significance (ASCUS), 58 (2.1%) of ASC-H, 273 (9.8%) LGSIL and 34 (1.2%) HGSIL. An analysis on antepartum HSIL or ASC-H results was performed.
Post partum specimens were available in 24 patients with HSIL, 14 (58.3%)of which were classified as high grade by cytology or histology and 2 as ASC-H (Tables 1-2). Follow-up in women with ASC-H (35) included high grade results in 7 (20%) cases and ASC-H in 1 patient. Eight patients (33.3%) with antepartum HSIL and 27 (77%) with ASC-H had LSIL or less on post partum follow-up.

Table 1. Postpartum follow-up results with Histology.

	NEG	CIN 1	CIN 2	CIN 3
HSIL	2(18.2%)	0	7(63.6%)	2(18.2%)
ASC-H	4(30.8%)	6(46.2%)	2(15.4%)	1(7.7%)

Table 2. Postpartum follow-up results with Cytology only

	NILM	LSIL	HSIL	ASC-US	ASC-H
HSIL	1(7.7%)	4(30.8%)	5(38.5%)	1(7.7%)	2(15.4%)
ASC-H	12(54.5%)	3(13.6%)	4(18.2%)	2(9.1%)	1(4.5%)

Conclusions: In a high risk patient population, the number of pregnant women diagnosed with squamous cell abnormality is higher. There is no difference in incidence of a high grade lesion on a postpartum sample in the study group when compared to non-pregnant women. Although ASC-H is a poorly reproducible diagnosis, it has a significant predictive value for an underlying high grade lesion. Our data shows that significant number of patients diagnosed with ASC-H or HSIL on antepartum Pap smear have a persistent high grade lesion postpartum. Possible explanation for follow-up results less than HSIL include regression, sampling or interobserver variability.
Category: Cytopathology

Tuesday, March 1, 2011 9:30 AM

Poster Session III # 92, Tuesday Morning