Follow up of Atypical Squamous Cell Pap Smears in Iraqi Women

Intisar S Pity,Maida Y Shamdeen,Shawnim A Wais

doi:10.7314/apjcp.2012.13.7.3455

Intisar S Pity, Maida Y Shamdeen + Show 1 more

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https://doi.org/10.7314/apjcp.2012.13.7.3455

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Abstract

To report the prevalence of atypical squamous cells of undetermined significance and atypical squamous cells-cannot exclude high squamous intraepithelial lesion and to determine the possible association of Pap test results with high-risk human papillomavirus and high squamous intraepithelial lesions in women from Duhok, Iraq. A prospective, observational study was conducted between January 2005 and December 2011. Overall, 596 women with a cervicovaginal Pap test showing atypical squamous cells of undetermined significance and 93 atypical squamous cells-cannot exclude high squamous intraepithelial lesion for whom pathologic follow-up was available were studied. Follow-up consisted of repeat cytology, colposcopy and histology. High risk human papillomavirus DNA testing was performed on exfoliated cervical cells from 106 women, using conventional PCR after at least 36 months from the initial Pap smear. Significantly high proportions of both atypical squamous cells of undetermined significance (87.9%) and atypical squamous cells-cannot exclude high squamous intraepithelial lesion (62.4%) demonstrated no significant lesion on subsequent follow up. Low squamous intraepithelial lesions were observed in 1.7% of cases of atypical squamous cells of undetermined significance and in 5.4% of atypical squamous cells-cannot exclude high squamous intraepithelial lesion. High squamous intraepithelial lesion was demonstrated in 0.8% and 16.1% respectively. In the latter there was also one case of invasive carcinoma. High-risk HPV DNA was demonstrated in 40% of atypical squamous cells of undetermined significance and 57.1% of atypical squamous cells-cannot exclude high squamous intraepithelial lesions. Since both atypical squamous cells of undetermined significance and atypical squamous cells-cannot exclude high squamous intraepithelial lesion identify patients who are at an increased risk for the development of high squamous intraepithelial lesions and a considerable percentage harbor high risk-HPV, both should be retained as diagnostic categories and patients warrant a diligent follow up and testing for high risk-HPV DNA. Colposcopic evaluation and biopsy, when indicated, are a must.

Highlights

Atypical squamous cell (ASC) is a name given, in a Pap smear or cervicovaginal cytology, to squamous cells that do not have a normal appearance but are not clearly precancerous
Since both atypical squamous cells of undetermined significance and atypical squamous cells-cannot exclude high squamous intraepithelial lesion identify patients who are at an increased risk for the development of high squamous intraepithelial lesions and a considerable percentage harbor high risk-human papillomavirus (HPV), both should be retained as diagnostic categories and patients warrant a diligent follow up and testing for high risk-HPV DNA
Two hundred and fourteen women were excluded from the study as there was no follow up (n=117), atypical squamous cells of undetermined significance (ASC-US)/ASC-H diagnosis was not confirmed on further review (n=81) or when patients had clinically significant diagnoses defined as high squamous intraepithelial lesions (HSIL), low squamous intraepithelial lesion (LSIL), cervical adenocarcinoma in situ or invasive cervical carcinoma prior to the ASC Pap smear (n=16)

Summary

Introduction

Atypical squamous cell (ASC) is a name given, in a Pap smear or cervicovaginal cytology, to squamous cells that do not have a normal appearance but are not clearly precancerous. In addition to the possible progression of ASC-US and ASC-H into HSIL or invasive malignancy, the link between these lesions and high risk-human papillomavirus (HR-HPV) creates a great incentive to investigate the clinically significant association with these two cytologic entities (Solomon et al, 2001; Chivukula and Shidham, 2006; Bandyopadhyay et al, 2008). To clarify this paradox we propose initiated this study to monitor the cytological and histological results of women with ASC-US and ASC-H Pap smears for a 7 year period to determine the possible association of these abnormal Pap smears with HR-HPV and HSIL in women from Duhok Governorate, Iraq. To the best of our knowledge, this is the first prospective clinical study in Iraq

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