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Qualification of ASCUS
A Comparison of Equivocal LSIL and Equivocal HSIL Cervical Cytology in the ASCUS LSIL Triage Study

Mark E. Sherman MD, Diane Solomon, Mark Schiffman
DOI: http://dx.doi.org/10.1309/JM3V-U4HP-W8HJ-68XV 386-394 First published online: 1 September 2001

Abstract

Cytologic detection of high-grade squamous intraepithelial lesions (HSILs) is critical to cervical cancer prevention. Therefore, identifying “equivocal HSIL” (ASCUS [atypical squamous cells of undetermined significance]-H) may be useful. Accordingly, we compared findings associated with “equivocal low-grade SIL” (ASCUS-L), ASCUS-H, and HSIL using data from the ASCUS LSIL (low-grade squamous intraepithelial lesion) Triage Study. The frequency of oncogenic human papillomavirus (HPV) DNA detection and underlying lesions cervical intraepithelial neoplasia (CIN) 2 or worse or CIN 3 or worse in women with ASCUS-H was intermediate between that of ASCUS-L and HSIL. Oncogenic HPV DNA was associated with 85.6% of ASCUS-H ThinPreps and 69.8% of ASCUS-H smears. Histopathologic lesions CIN 2 or worse were associated with 40.5% of ASCUS-H ThinPreps and 27.2% of ASCUS-H smears (mostly CIN 3). Nevertheless, numerically more lesions CIN 2 or worse were preceded by ASCUS-L than by ASCUS-H because ASCUS-L was more common. ASCUS-H is an uncommon interpretation that derives clinical usefulness from its high positive predictive value for lesions CIN 2 or worse.

Key Words:
  • Bethesda System
  • ASCUS
  • Atypical squamous cells of undetermined significance
  • Papillomavirus
  • Screening
  • ALTS
  • ASCUS LSIL Triage Study
  • Cervix
  • Atypical
  • Metaplasia