Follow-up of Papanicolaou smears diagnosed as atypical squamous cells of undetermined significance

✍ Scribed by Lydia Pleotis Howell; Robin L. Davis

• Publisher: John Wiley and Sons
• Year: 1996
• Tongue: English
• Weight: 633 KB
• Volume: 14
• Category: Article
• ISSN: 8755-1039
• DOI: 10.1002/(sici)1097-0339(199602)14:1<20::aid-dc5>3.0.co;2-z

✦ Synopsis

In the first year since the institution of the Bethesda system at UCDMC, 549/7,388 (7.43%) Papanicolaou (Pap) smears were diagnosed as having an epithelial abnormality. One hundred ninety-three of the 549 (35. I %) of the abnormal smears received an ASCUS diagnosis, representing 2.61 % of the total volume. Follow-up was obtained on 124/193 (64.2%) and consisted of colposcopy with biopsy in 38.3%. one repeat Pap smear in 51.2%, and two or more repeat Pap smears in 10.5%. Follow-up revealed a squamous intraepithelial lesion (SIL) in 29. I %, ASCUS in 12.9%, and no evidence of an epithelial lesion in 58.0%. Review of the original ASCUS Pap smear from the group with no epithelial lesion on follow-up showed increased inflammation plus metaplasia and/or reactive changes in 69.5% and ASCUS in 19.5%.

This study demonstrates that a signi5cant percentage of ASCUS Pap smears represent SIL. However, many Pap smears with reactive, inflammatory changes are misclassified as ASCUS and would be best diagnosed under "Reactive/Reparative Changes" in the Bethesda system. Careful attention to criteria for ASCUS and inflammatory and reactive atypia is recommended to avoid misclassijfcation and to make this category more meaningf u l to the clinician.