Abstract
The concept that the presence of atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions (ASC-H) was introduced in the 2001 Bethesda System of cervical cytology classification. This nomenclature defines cervical cancer precursor lesions. The objective of this study was to investigate the colpocytological-histological results from a three-year follow-up conducted on a cohort of women with reports of ASC-H who were attended during 2005-2006 at clinics of the Southern Metropolitan Healthcare Service of Santiago, Chile. Prospective cohort study at primary healthcare clinics in Santiago, Chile. Colpocytological-histological follow-up was conducted over a three-year period on 92 women with cytological reports of ASC-H who were attended at primary healthcare clinics during 2005-2006. At the end of the follow-up period, high-grade lesions were evaluated and the following outcomes were observed: seven women presented invasive cancer (7.6%), 49 presented high-grade lesions (53.3%), 26 presented low-grade lesions (28.2%) and 10 presented normal results (10.9%). The "Conditional Probabilities Tree Diagram" was used to show the results from tests and the times of lesion detection. It demonstrated that, after a first report of ASC-H, clinical management needed to be interventionist. The follow-up on our cohort of women showed that the majority of uncertain ASC-H diagnoses (82.6%) had abnormal colposcopic results and that during the follow-up using ASC-H smears, two out of every three women developed high-grade lesions.
Highlights
The concept that the presence of atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H) was introduced by the 2001 Bethesda System of cervical cytology classification
Through a consensus among expert pathologists, it was concluded that atypical squamous cells of undetermined significance (ASCUS)-H represented a cytological category that differed from ASCUS-L and high-grade squamous intraepithelial lesion (HSIL).2
Out of the 88,438 cervical exfoliative smears collected, 752 (0.85%) were atypical Pap smears. The latter contained atypical squamous cells, which were divided into atypical squamous cells of undetermined significance (ASC-US) (619 cytological tests, 0.69%) and atypical squamous cells that cannot exclude highgrade squamous intraepithelial lesion (ASC-H) (106 cytological tests, 0.11%) (Table 1)
Summary
The concept that the presence of atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H) was introduced by the 2001 Bethesda System of cervical cytology classification. This system addresses the need to define a cytological category between atypical squamous cells of undetermined significance (ASCUS) and high-grade squamous intraepithelial lesion (HSIL).. ASCUS-H has been seen to present a risk association of 27.2% with cervical cancer precursor lesions, which is higher than the risk association for the ASCUS-L category of 11.4%, but lower than the risk association for HSIL of 44.8%.2,3 Subsequent studies, such as a study by Sherman et al, detected high-grade lesions (HSIL) in 41% of the women with initial ASC-H smears.. Through a consensus among expert pathologists, it was concluded that ASCUS-H represented a cytological category that differed from ASCUS-L and HSIL. ASCUS-H has been seen to present a risk association of 27.2% with cervical cancer precursor lesions, which is higher than the risk association for the ASCUS-L category of 11.4%, but lower than the risk association for HSIL of 44.8%.2,3
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