Atypical Squamous Cells Of Undetermined Significance Results Research Articles

The Value of Four-Quadrant Cervical Biopsy in Women with Different Colposcopic Impressions.

The aim of this study was to compare the diagnostic efficacy of colposcopic-directed biopsy and four-quadrant biopsy in detecting high-grade cervical intra-epithelial neoplasia (CIN). Women attending three women's clinics for routine cervical screening were recruited. Colposcopy was arranged for women with any cytologic abnormalities greater than atypical squamous cells of undetermined significance (ASCUS), two consecutive ASCUS results or positive HPV testing. During colposcopy, a cervical biopsy was taken from the most suspicious area, but more than one biopsy was allowed. Four-quadrant biopsies at 3, 6, 9 and 12 o'clock and an endocervical curettage were also taken in all cases. A total of 1522 colposcopies were performed in 1311 subjects from June 2010 to August 2017, with 118 cases of high-grade CIN diagnosed. Colposcopic-directed biopsy detected 50.8% of the 118 high-grade CIN, while four-quadrant biopsy detected 86.4% (p < 0.0001). Twenty-seven cases (22.9%) of high-grade CIN were diagnosed in women with normal or unsatisfactory colposcopy. Among the 64 cases with low-grade colposcopic impression, four-quadrant biopsy detected significantly more high-grade CIN (53 cases, 82.8%) than colposcopic-directed biopsy (35 cases, 56.3%) (p = 0.0011). Four-quadrant cervical biopsies should be considered for all women with an abnormal smear or positive HPV testing, especially in patients with low-grade/normal/unsatisfactory colposcopy.

Anal dysplasia in adolescent and young adult men who have sex with men: a single-center retrospective and descriptive study (2010-2020).

There are limited studies evaluating anal cytology results or the prevalence of anal human papiloma virus in adolescent and young adult (AYA) men who have sex with men (MSM). The purpose of this study was to review anal cytology screening results and determine whether abnormal findings resulted in completion of anoscopy in AYA MSM (13-26 years old). This was a retrospective study evaluating 84 anal Papanicolaou screening results among 36 AYA MSM patients aged 13-26 years who had an anal Papanicolaou test completed at an outpatient Adolescent/Young Adult Medicine Practice at Boston Children's Hospital, an urban, nonprofit, academic, free-standing children's hospital, from January 1, 2010, to December 31, 2020. The findings of anal Papanicolaou screening included atypical squamous cells of undetermined significance (ASCUS) (37%), negative for squamous intraepithelial lesion (31%), inability to read (21.3%), and low-grade squamous intraepithelial lesion (10.8%). Most patients who had ASCUS results were referred for anoscopy (n = 28, 90.3%), and of those referred only 6.5% (n = 2) completed an anoscopy. Of those with low-grade squamous cell intraepithelial lesion results, 88.9% (n = 8) were referred for anoscopy, and among those who were referred, only 3.3% (n = 3) had completed an anoscopy. This study showed that there were abnormalities in cytology when anal Papanicolaou test screening was performed in this population, and the completion rates for anoscopy were low.

Vajinal İnfeksiyon ile Atipik Pap-smear Sonuçları Arasındaki İlişkinin Değerlendirilmesi

Introduction: This study aims to evaluate the frequency of infectious agents in Pap-smear results and their association with pathological results. Materials and Methods: This retrospective study was conducted by evaluating the smear results between January 1, 2021 and December 31, 2021 at the Tuzla State Hospital. Smear results were classified according to the Bethesda system [normal, atypical squamous cells of undetermined significance (ASC-US), atypical squamous cells-high-grade (ASC-H), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), atypical glandular cells (AGC) carcinoma]. In addition, vaginitis agents (Trichomonas vaginalis, Gardnerella vaginalis, Candida spp., Actinomyces spp.) found in the report were also recorded separately. Results: In the study, as a result of the evaluation of 4708 smear results, a vaginal infectious agent was found in 675 patients (16.55%). G. vaginalis was observed most frequently in 322 patients (7.9%), and the Candida spp. was observed in 298 patients (7.3%). Actinomyces spp. was observed in eight patients and T. vaginalis was observed in two patients. Pathology results were normal in 4129 (87.7%) according to the 2014 Bethesda system. Five hundred and fifty (11.68%) of them were ASC-US, nine (0.19%) ASC-H, 17 (0.36%) LSIL, and three (0.06%) were reported as HSIL. G. vaginalis was accompanied in 29 of the ASC-US results, and Candida spp. accompanied 10. Candida spp. was observed in 2 of 9 patients diagnosed with ASC-H, and G. vaginalis was observed in one of them. G. vaginalis was found in 1 of 17 patients diagnosed with LSIL, and no infection was found in three patients diagnosed with HSIL. Conclusion: Routine Pap-smear examination is essential for identifying cervicovaginal infectious agents as well as cervical pathologies.

Servikal kanser taramasında saptanan önemi belirlenemeyen atipik skuamoz hücrelerin klinik değerlendirmesi: Eskişehir deneyimi

Purpose : Aim of our study is to compare the colposcopic findings with the histopathologic results of atypical squamous cells of undetermined significance (ASCUS) diagnosed during cervical cytological screening in patients applied with various complaints and evaluated with co-test so as to to determine the clinical value of it. Materials and Methods: In this retrospective analysis 177 patients who attended between January 2011 and may 2020, aged between 24-74 years, with the result of ASCUS in their Pap smear tests, were enrolled. Colposcopic findings of cases were classified according to Reid Colposcopic Index (RCI) and compared with the histopathologic results. Results: 177 patients were analyzed and the mean age of them was 37,1±1,41 (24-74), parity 2,8±1.07 (0-11) and mean smoking was found to be 6 cigarettes/day (0-40 cigarettes/day). 148 (%83,6) of cases were in premenapouse, 29 (%16,3) of them were in postmenapousal period. 68 (%38,4) patients were diagnosed as chronic cervicitis by colposcopy assisted cervical biyopsy, rest 108 (%61,0) were determined as cervical intraepithelial lesions (CIN) [85 (%48) CIN 1, 16 (%9) CIN 2, 7 (%3,9) CIN 3] and 1(%0,5) patient was found to be cervical carcinoma (CX CA). Comparison between HPV DNA types and RCI with biopsy results was analyzed with Pearson Exact Chi-square test and found to be statistically significant between groups (p<0.001). Conclusion: Our results put forth that colposcopic evaluation is needed in patients with cytologic ASCUS results even if HR-HPV DNA test is negative. That's why Pap smear test cannot be replaced by screening only with HR-HPV DNA, co-test requirement showed to be more suitable because of cytologic evaluation involvement.

Follow-up of squamous atypia’s and the evaluation of the conducts according to the recommendations of the Ministry of Health

ABSTRACT Introduction: Cervical cancer is considered a public health problem, ranking fourth among the most common types of cancer worldwide. Objective: The present study aimed to gather information on the follow-up, and to verify adherence to the management recommended by the Brazilian Ministry of Health (MH) of women with cervical cytopathological results of atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion (ASC-H), as well as to evaluate the quality of cytopathology tests of the laboratory that provides services to the Brazilian Unified Health System (SUS). Methods: Cervical cytopathology results of squamous atypia were researched between the years 2016 and 2017 in standardized requirements from the MH. The performance of the laboratory that carried out the cytopathology tests were analyzed using indexes recommended in the Internal Quality Monitoring (IQM) of the MH [Quality Management Manual (QMM)]. Results: 42,478 cytopathology tests were evaluated, 893 of these presented ASC-US results, and 199 ASC-H results. In women with ASC-US results, 73.2% repeated the cytopathology test, of which 18.7% remained the altered result, and 81.3% were negative for malignancy. Following the recommendation of the MH, 81.9% of women repeated the test outside the recommended period. In women with ASC-H, 51.8% underwent histopathological examination as recommended by the MH, of which 73.8% were altered. Conclusion: According to the MH Guidelines, most (81.9%) women with ASC-US repeated the cytopathology test

Retrospective analysis of cervical cancer and precancerous lesions in patients with atypical squamous cells of undetermined significance in China

Atypical squamous cells of undetermined significance (ASCUS) are the most common cytological abnormality of all smear test. No study has demonstrated the prevalence of cervical cancer or its precursor in Chinese patients with ASCUS. This study aims to investigate the prevalence of cervical intraepithelial neoplasia 1 or worse (CIN1+) and CIN3 or worse (CIN3+) in patients with ASCUS in China to provide insight into appropriate management for Chinese health care.In a retrospective cross-sectional study, patients who underwent liquid-based thin layer cytology and human papillomavirus (HPV) co-testing at the Peking Union Medical College Hospital between January 2014 and January 2017, and had ASCUS results on liquid-based thin layer cytology test and underwent follow-up and colposcopic biopsy were included. Age, HPV DNA test, and pathological outcomes were assessed.One hundred forty-four patients with ASCUS and positive HPV test results were included. In the 3-year follow-up, 23 (16.0%) patients had CIN1, 28 (19.4%) had CIN2, and 17 (11.8%) had CIN3 or carcinoma in situ. The risk of CIN3+ was significantly higher in those older than 60 years (42.8%, P = .005), whereas the CIN1+ prevalence displayed no significant difference between age groups. Both hybrid Capture II (HC II) value and cytopathological description of HPV infection showed no statistically significant correlation with CIN1+ or CIN3+.Patients with HPV-positive ASCUS who were older than 60 years had a significantly higher risk of CIN3+, and clinicians should pay more attention to them. Both HC II value and cytopathological description of HPV infection showed no significant correlation with CIN1+ or CIN3+.

2274. Assessment of Anal Papanicolaou Smear Screening and Follow-up Rates in Eastern North Carolina for HIV-Positive Patients Who Are Men Who Have Sex With Men

The purpose of this research is to show the prevalence of anal Pap smear abnormalities and follow-up activities among MSM patients receiving HIV care at the ECU Infectious Diseases and International Travel Health Clinic (ECU ID).BackgroundSquamous cell carcinoma of the anus (i.e. anal cancer), represents 0.5% of all new cancer cases in the United States in 2017 according to the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. Literature shows that the HIV-infected men who have sex with men (MSM) population is 52 times more likely to develop anal cancer compared with the non-HIV-infected population. Anal Pap screenings have the potential to detect the presence of anal cancer earlier, but no national guidelines exist for performing anal Papanicolaou (Pap) screens among MSM.MethodsA retrospective chart review was performed on 505 qualifying patients. Baseline data about anal Pap screening and follow-up rates were gathered. Data were collected from January 1st, 2016 to May 31st, 2017.ResultsAnal Pap smear abnormality findings: Atypical Squamous cells of Undetermined Significance (ASCUS), Low Grade Squamous Intraepithelial Lesion (LGSIL), High Grade Squamous Intraepithelial Lesion (HGSIL). ConclusionOur results indicate variation in practice among providers at ECU ID Clinic regarding the screening, the need for a follow-up, and the type of follow-up provided. Additionally, research shows that anal cancer is one of the non-defining AIDS cancers whose incidence increases as the patient ages. However, based on the data, anal cancer screening decreases as the patient ages at the ECU ID clinic. Therefore, a standardized clinic protocol is needed, which may help improve the screening and follow-up rates. Also, a higher percentage of patients with an ASCUS result do not receive follow-up when compared with patients with an LGSIL and HGSIL result. Future research to determine the significance of follow-up for patients with an ASCUS result should be explored.Disclosures All authors: No reported disclosures.

Management of Atypical Squamous Cell Cases: A Prospective Study of Women seen at a Private Health Service in Northeastern Brazil.

To assess the management chosen by gynecologists after atypical squamous cells (ASCs) cytology results, and to evaluate the outcomes of these cases in Brazilian women. A prospective observational study evaluated the initial management offered by the gynecologist in the case of 2,458 ASCs cytology results collected between January of 2010 and July of 2016. The outcomes of the cytology, high-risk human papilloma virus (HR-HPV) test and histology were compared in two subgroups: atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H). In many cases of ASC-US (36.97%) and ASC-H (40.50%), no clinical actions were taken. Cytology was the most frequent follow-up chosen, including for cases of ASC-H, which goes against the conduct recommended in the national guideline. In women over 30 years of age, the period of time elapsed between an ASC-US result and a new cytology was in 13.03 months, in disagreement with the national guideline recommendations (p < 0.0001). Negative for intraepithelial lesions or malignancy (NILM) cytologic (p = 0.0026) and histologic (p = 0.0017) results in the follow-up were associated with prior ASC-US, while negative results for ASC-H were cytologically (p < 0.0001) and histologically associated with high-grade squamous intraepithelial lesion (HSIL) (p < 0.0001). Two invasive cervical carcinomas (ICCs) were found in the follow-up for ASC-H, and there was a statistically significant association (p = 0.0341). A positive HR-HPV test was associated with ASC-H (p = 0.0075). The data suggest that even for a population of Brazilian women assisted at private clinics, the national guidelines recommendations for ASCs results are not followed.

Liver transplant recipients have a higher prevalence of anal squamous intraepithelial lesions

Background:Anal squamous intraepithelial lesions (ASIL) are precancerous lesions of anal squamous cell carcinoma, with a higher prevalence in immunosuppressed patients. There are some studies in kidney transplant recipients, but there is no information regarding prevalence in liver transplantation. Our aim was to evaluate the prevalence of ASIL in this setting.Methods:Prospective case–control study involving liver transplant recipients without any other known risk factor for ASIL (n=59), which were compared with a healthy control group (n=57). All were submitted to anal cytology and high-resolution anoscopy was performed in those with abnormal results.Results:Ten (17%) of liver transplant recipients had abnormal cytological results, seven patients had atypical squamous cells of undetermined significance (ASC-US), one patient had atypical squamous cells that cannot exclude high-grade (ASC-H) and two patients had high-grade squamous intraepithelial lesions (HSIL). In the control group, one patient (2%) had an ASC-US result (P=0.005). Anal squamous intraepithelial lesions were confirmed in 7 out of 10 of liver transplant patients and 0 out of 1 in the controls (P=0.013) by high-resolution anoscopy with biopsies. Current smoking was the only risk factor for abnormal cytology (odds ratio=5.87, 95% confidence intervals=1.22–28.12, P=0.027).Conclusions:Liver transplant patients have a higher risk of ASIL. Screening should be considered, especially in smokers.

Risk assessment on cervical cancer in women with cytology atypical squamous cells of undetermined significance but negative human papillomavirus

To assess the risk of cervical cancer and high grade cervical intraepithelial in women with negative human papillomavirus (HPV) and cytology atypical squamous cells of undetermined significance (ASC-US) and to provide evidence for clinical management. We pooled 17 population-based cross-sectional studies which were conducted across China from 1999 to 2008. Totally, 30 371 women aged 17-59 were included in these studies. All women received liquid-based cytology test (LBC), HPV testing (hybrid capture 2 test, HC2) and visual inspection with acetic acid test (VIA). Women with any positive result from above tests were referred to colposcopic examination. Totally, 28 810 women with complete results from HPV, cytology and pathology were included in the final analysis. Women with negative HPV (LBC-/HPV-) or negative cytology (LBC-) results served as the control, respectively. Risk on high grade cervical intraepithelial neoplasia (CIN2+) was calculated for women with HPV negative and ASC-US results (ASC-US/HPV-). There were 22 003 women with LBC-/HPV-, 24 139 women with LBC-, and 1 834 with ASC-US/HPV- indentified in our study. CIN2+prevalence rates to the above women appeared as 0.05%, 0.36% and 0.16%, respectively. Compared with women with LBC-/HPV- and women with LBC-, the odds ratios (ORs) for CIN2+in women with ASC-US/HPV-were 3.00 (95%CI: 0.85-10.65) and 0.46 (95%CI:0.15-1.45), with adjusted ORs as 4.00 (95%CI: 1.08-14.87) and 0.47(95%CI: 0.15-1.49), respectively. The risk of CIN2+ in women with ASC-US/HPV- was in between the risks of women with LBC-/HPV- or with LBC-. Based on the "equal risk, equal management" principle, women with ASC-US/HPV- were suggested to be followed under the '3-year interval' program, which was the same as for those cytology negative women. However, in areas with limited health resources, the follow-up interval can be extended to 5 years, similar to the management on women with LBC-/HPV-.

Diagnostic Approach to Patients with Atypical Squamous Cells of Undetermined Significance Cytologic Findings on Cervix

Background:Atypical squamous cells of undetermined significance (ASCUS) is a term that refers to inflammatory, reactive and reparative processes which are atypical and of higher level and insufficient to be classified as cervical intraepithelial lesions (CIN).Aims:Examine of frequency of HPV infection in ASCUS lesions and regression, stagnation and progression during six-month period.Subjects and Methods:Prospective study was conducted over a period of 3 years. In private gynecological ambulance „Dr Mahira Jahic”. Analysis of PAP smears and HPV typization have been done in 50 patients and PAP test has been repeated after six months. X² test was used for statistical analysis.Results:Analysis of 1784 PAP smears showed normal results in 86,6% (N-1530), and abnormal in 13% (N-254). ASCUS in 7,4% (N-133) and ASC-H in 0,5% (N-9), LSIL in 4,4% (N-80), HSIL in 1,3% (N-24), CIN II in 1,2% (N-20), CIN III in 0,2% (N-4). Progression occurred in 18% (9), persistence in 74% (37) and regression in 8%. Patients with ASC-H lesion 0,5% (N-9), PH results showed 22% (N-2) Carcinoma in situ, 33% (N-3) CIN II, 22% (N-2) CIN I and 22% (N-2) chronic cervicitis. Patients with CIN I in 88% (N-7) were positive on HPV of high risk. Patients with persistent ASCUS result were positive in 51% (N-19). The number of CIN I lesions found in women with ASCUS is bigger and statistically significant (p<0,05) in relation to number of CIN I findings found in regular examinations.Conclusion:Monitoring women with ASCUS lesion, especially HPV positive to high risk group is the best way of selection of women who should be treated and monitored in order to prevent cervical cancer.

Cost-Effectiveness Analysis of Different Management Strategies for Detection CIN2+ of Women with Atypical Squamous Cells of Undetermined Significance (ASC-US) Pap Smear in Thailand.

To identify the optimal cost effective strategy for the management of women having ASC-US who attended at King Chulalongkorn Memorial Hospital (KMCH). An Economical Analysis based on a retrospective study. The women who were referred to the gynecological department due to screening result of ASC-US at King Chulalongkorn Memorial Hospital, a general and tertiary referral center in Bangkok Thailand, from Jan 2008 - Dec 2012. A decision tree-based was constructed to evaluate the cost effectiveness of three follow up strategies in the management of ASC-US results: repeat cytology, triage with HPV testing and immediate colposcopy. Each ASC-US woman made the decision of each strategy after receiving all details about this algorithm, advantages and disadvantages of each strategy from a doctor. The model compared the incremental costs per case of high-grade cervical intraepithelial neoplasia (CIN2+) detected as measured by incremental cost-effectiveness ratio (ICER). From the provider's perspective, immediate colposcopy is the least costly strategy and also the most effective option among the three follow up strategies. Compared with HPV triage, repeat cytology triage is less costly than HPV triage, whereas the latter provides a more effective option at an incremental cost-effectiveness ratio (ICER) of 56,048 Baht per additional case of CIN 2+ detected. From the patient's perspective, the least costly and least effective is repeat cytology triage. Repeat colposcopy has an incremental cost-effectiveness (ICER) of 2,500 Baht per additional case of CIN2+ detected when compared to colposcopy. From the sensitivity analysis, immediate colposcopy triage is no longer cost effective when the cost exceeds 2,250 Baht or the cost of cytology is less than 50 Baht (1USD = 31.58 THB). In women with ASC-US cytology, colposcopy is more cost-effective than repeat cytology or triage with HPV testing for both provider and patient perspectives.

Provider management of equivocal cervical cancer screening results among underserved women, 2009-2011: follow-up of atypical squamous cells of undetermined significance.

Reflex human papillomavirus (HPV) testing is the preferred triage option for most women diagnosed with atypical squamous cells of undetermined significance (ASC-US). This study was conducted to describe follow-up results of women with ASC-US Pap test results in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), focusing on HPV test use. We examined the follow-up of 45,049 women in the NBCCEDP with ASC-US Pap tests during 2009-2011. Data on demographic characteristics, diagnostic procedures, and clinical outcomes were analyzed. NBCCEDP providers diagnosed 45,049 women (4.5 % of all Pap tests) with an ASC-US result. Of those, 28,271 (62.8 %) were followed with an HPV test, 3,883 (8.6 %) with a repeat Pap test, 6,592 (14.6 %) with colposcopy, and 6,303 were lost to follow-up (14.0 %). Women aged 40 and older were followed more often with an HPV test. White, black, and Asian/Pacific Islander women were followed more often with an HPV test after an ASC-US Pap compared to Hispanic and American Indian/Alaska Native (AI/AN) women. Among women with a positive HPV test on follow-up, almost 90 % continued with colposcopy as recommended. AI/AN women had the highest rates of HPV positivity (55.2 %) and of no follow-up (25.0 %). This is the first analysis describing follow-up of ASC-US Pap test results in the NBCCEDP, providing a window into current management of ASC-US results. Findings raise concerns about persistent disparities among AI/AN women. During 2009-2011, nearly two-thirds of women with an ASC-US Pap test result were followed with an HPV reflex test.

Evaluation of Endocervical Canal in Women With Minimal Cervical Cytological Abnormalities

This study aimed to examine the endocervical canal curettage (ECC) results of patients with atypical squamous cells of undetermined significance (ASC-US) or low-grade intraepithelial lesion (LSIL) and secondarily to explore the features of patients who are at greatest risk for endocervical involvement. This is a retrospective analysis of 846 women who underwent ECC with ASC-US or LSIL on cervical cytology between January 2003 and April 2011. Records of demographic data and colposcopic impression were evaluated. Histopathological results of biopsies and ECC were classified into 2 categories as less than cervical intraepithelial lesion 2 (CIN 2) and CIN 2+ lesions for comparison. Multivariate analysis was performed using binary logistic regression analysis to identify predictors of ECC results. CIN 1 lesions were detected in 8.9% of patients, and the rates of CIN 2 or 3 and invasive/microinvasive cancers in ECC were 3.8% and 0.7%, respectively. Cervical intraepithelial lesion 2 or worse lesions were detected in 1.6% (7/419) of the patients with normal colposcopic findings. There was no statistically significant difference in the rate of CIN 2+ lesion in endocervical canal between the patients with or without satisfactory colposcopic examination (4.4% vs 4.1% p = .69). A total of 1.7% of the patients who did not have cervical biopsy and also 1.1% of the patients who had less than CIN 2 biopsy results were diagnosed with CIN 2+ lesion by ECC despite the satisfactory colposcopy. Only a positive biopsy result for dysplasia was found to be an independent factor for the detection of a dysplastic lesion in endocervical canal (odds ratio = 0.06; 95% CI = 0.01-0.35; p = .02). Endocervical canal curettage had minimal diagnostic utility for the detection of CIN 2 or worse lesions in women with ASC-US or LSIL smear result and normal colposcopic findings. In addition to this, the presence or absence of CIN 2+ lesions diagnosed by means of endocervical curettage was independent of a satisfactory or unsatisfactory colposcopic examination.

Updates of the current screening guidelines for the early detection of cervical cancer

Updates of the current screening guidelines for the early detection of cervical cancer

Is the Colposcopically Directed Punch Biopsy a Reliable Diagnostic Test in Women With Minor Cytological Lesions?

The study aimed to determine the accuracy of the colposcopy-directed punch biopsy (punch) to detect or exclude high-grade cervical intraepithelial neoplasia (CIN 2 or 3) in women with atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL) cytological result and minor colposcopic findings. In a diagnostic test accuracy study, women with ASCUS or LSIL cytological result and minor colposcopic changes had a single colposcopy-targeted punch biopsy was performed immediately followed by a loop electrocautery excision procedure (LEEP) biopsy. The trial was powered to detect a level of κ for a dichotomous outcome of 0.4 (i.e., fair-to-moderate agreement), with a two-sided significance level of 5% and a power of 90%. Accuracy parameters were computed using a cutoff for positive punch biopsy result of CIN 1+ and CIN 2+ for an outcome of CIN 2+ and CIN 3+ assessed in the LEEP specimen. Sixty-eight punch biopsy/LEEP-paired samples were analyzed. Of the 8 CIN 3 lesions, 6 and 4 were detected at cutoff CIN 1+ and CIN 2+, respectively (sensitivity, 50% and 75%). The corresponding specificities were 65% (39/60) and 97% (58/60). The punch biopsies identified only 14 (67%) or 6 (20%) of the 21 CIN 2+ lesions at cutoff CIN 1+ or CIN 2+, respectively. Of the punch biopsies, 31 (45.6%) accurately detected the severity of cervical abnormality. A single colposcopically directed punch biopsy appears to be insufficient to exclude underlying CIN 2 or 3.

Economic evaluation of strategies for managing women with equivocal cytological results in Brazil

In Brazil, current management of women with screening results of atypical squamous cells of undetermined significance (ASC-US) is to offer repeat testing at 6-month intervals. Alternative management strategies that have been adopted in many high-income settings are to offer immediate colposcopy referral or to utilise human papillomavirus (HPV) DNA testing as a triage for colposcopy referral, and to consider different strategies according to women's age. The objective of our study was to evaluate the lifetime cost effectiveness in terms of cost per years of life saved (YLS) of these alternative strategies for a middle income setting. A Markov model was developed using data from the Ludwig-McGill cohort and calibrated to independent observational datasets and local cost estimates obtained. In the base-case analysis, repeat cytology was the least costly strategy but also the least effective. Based on the WHO threshold for very cost-effective interventions, HPV triage for women above 30 years-old was the strategy with the highest probability of being cost effective. HPV triage including younger women with ASCUS results would also be a cost-effective option. Whilst there was a slight further gain in effectiveness with immediate colposcopy referral, it was also more expensive and did not appear to be cost effective. Threshold analysis indicated that an HPV test would have to be more than twice as expensive as a cytology test for HPV triage to no longer be cost effective. In conclusion, our results indicate that in middle income settings HPV triage is likely to be the optimal strategy for managing women presenting with ASC-US results.

The Sensitivity and Specificity of p16INK4a Cytology vs HPV Testing for Detecting High-Grade Cervical Disease in the Triage of ASC-US and LSIL Pap Cytology Results

We analyzed the performance of p16(INK4a) immunocytochemistry on a series of 810 retrospectively collected atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL) cases with available biopsy follow-up data, including 94 cases of cervical intraepithelial neoplasia (CIN) 2 and 128 cases of CIN 3. Human papillomavirus (HPV) testing was performed from the same residual liquid-based cytologic specimen, and results for both tests were correlated with histologic follow-up data. Sensitivity values for high-grade CIN (HGCIN) confirmed on biopsy within 6 months were 92.6% (ASC-US) and 92.2% (LSIL) for cytotechnologists' reviews of p16 cytology and 90.1% (ASC-US) and 95.7% (LSIL) for HPV testing. Sensitivity rates of initial pathologists' reviews were slightly lower, 76.4% to 80.1%, with levels comparable to cytotechnologists' results after adjudication. The specificity of p16 cytology for HGCIN detection was significantly higher than for HPV testing for cytotechnologists and pathologists: 63.2% to 71.1% (p16 cytology) vs 37.8% for HPV in ASC-US (P < .001) and 37.3% to 53.3% (p16 cytology) vs 18.5% for HPV in LSIL (P < .001). This evaluation of the diagnostic performance of p16 cytology confirms the potential of this stain for the efficient triage of ASC-US and LSIL cytologic results.

Lessons From Practice

To characterize the risks of cervical intraepithelial neoplasia 3 (CIN 3) and cancer in women aged 21 to 24 with human papillomavirus (HPV)-positive atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL) screening results in routine clinical practice. Quality assurance databases containing records of screening test and histologic findings from the Regional Laboratory of the Northern California Kaiser Permanente Medical Care Program were reviewed. Numbers of LSIL and HPV-positive ASC-US results and associated cancers and CIN 3 in women aged 21 to 24 during 2003 to 2007 were tabulated, and the corresponding risks were calculated overall and by year of age. During the 5-year period from 2003 to 2007, 1,620 HPV-positive ASC-US and 2,175 LSIL were diagnosed in women aged 21 to 24, for which corresponding histologic finding is available. No invasive cancers were detected in association with LSIL and HPV-positive ASC-US screening results in this age group during this period. The risk of cancer was therefore 0% (95% CI = 0.00%-0.10%). The risk of CIN 3 associated with an HPV-positive ASC-US was 2.90% (95% CI = 2.14%-3.84%), with LSIL was 2.44% (95% CI = 1.83%-3.18%), and, for the 2 combined, the risk was 2.64% (95% CI = 2.15%-3.20%). The risk of CIN 3 and cancer is low enough that management of women aged 21 to 24 with ASC-US and LSIL smears without immediate colposcopy should be considered, as is currently recommended for women aged 20 and younger.

Follow-up findings for women with human papillomavirus-positive and atypical squamous cells of undetermined significance screening test results in a large women's hospital practice.

Abstract Context.—Reflex human papillomavirus (HPV) testing has been designated in consensus guidelines as “preferred” for women with atypical squamous cells of undetermined significance (ASC-US) liquid-based cytology (LBC) results, and colposcopy is currently recommended for patients with HPV-positive ASC-US results. Data from large clinical practices using newer screening methods and current cytology terminology are limited. Objectives.—We analyzed data from patients with ASC-US LBC and positive HPV test results. We also assessed the impact of the presence or absence of an endocervical cell/ transformation zone sample (EC/TZS) on biopsy diagnoses. Design.—The information system of a large women's hospital serving an older-than-average population was searched over a 21-month period between July 1, 2005, and March 31, 2007, for HPV-positive cases interpreted as ASC-US (Bethesda System 2001) using computer-imaged LBC. Histologic diagnoses, patient ages, and presence or absence of an EC/TZS were analyzed. T...