Background:
Atypical squamous cells of undetermined significance (ascus) is a cytopathologic term used to describe cases without specific pathologic substratum. between 10-60% of ascus cases correspond to squamous intraepithelial lesions (sil).
Methods:
The objectives of this study were: 1) to detect the pathologic significance of ascus in study patients, 2) to determine whether papnet identifies these cases, and 3) to compare the results of papnet with those of a second conventional screening. one hundred and sixty-three consecutive patients with the cytologic diagnosis of ascus and adequate follow-up were selected. of these, 111 patients had colposcopic lesions and biopsies were performed; in the remaining 52 cases colposcopy was negative, as were 3 consecutive annual papanicolaou smears. in a blind review, all 163 cases were rescreened using papnet. a second manual screening was performed for comparison.
Results:
One hundred and twenty-six of the 163 cases (77.3%) showed no sil on biopsy or follow-up. of the 37 pathologic cases, the diagnosis was koilocytosis (flat condyloma) in 13 cases (8%), cervical intraepithelial neoplasia (cin) type i in 11 cases (6.8%) low grade sil [lsil] in a total of 24 cases [14.8%]), and cin ii-iii or high grade sil (hsil) in 11 cases (6.8%). in the review using papnet, 57 previous ascus cases were classified correctly as negative, and 7 of 13 koilocytosis cases (54%), 9 of 11 cin i cases (82%), and 7 of 11 cin ii-iii cases (64%) were diagnosed correctly. in the second conventional screening, 74 cases were negative and 77 cases were ascus; only 3 of 13 koilocytosis cases (23%), 4 of 11 cin i cases (36.4%) and 5 of 11 cin ii-iii cases (45.5%) were reclassified correctly.
Conclusions:
Among 163 patients with ascus, 77.3% had no precancerous squamous lesions. concordance with definitive diagnosis was more accurate in our study using papnet analysis (kappa index [k] = 0.7158) than by second conventional screening (k = 0.4537). furthermore, we reclassified 35% of smears as negative and 15% as sil.