Outcomes and Management of Atypical Squamous Cells-Cannot Exclude High-Grade Squamous Intraepithelial Lesion in a Primary Human Papillomavirus Screening System.

Maria A Cheung, Ciaran D McKeown, Claire M McCarthy
{"title":"Outcomes and Management of Atypical Squamous Cells-Cannot Exclude High-Grade Squamous Intraepithelial Lesion in a Primary Human Papillomavirus Screening System.","authors":"Maria A Cheung, Ciaran D McKeown, Claire M McCarthy","doi":"10.5858/arpa.2024-0423-OA","DOIUrl":null,"url":null,"abstract":"<p><strong>Context.—: </strong>\"Atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion\" (ASC-H) cytology is uncommon (0.16%-0.43%). The reported risk of high-grade dysplasia varies hugely (12.00%-70.00%), making management challenging. Primary human papillomavirus (HPV) screening requires an updated understanding of ASC-H.</p><p><strong>Objective.—: </strong>To review ASC-H colposcopic and histologic comparators, and management outcomes, to help guide future management.</p><p><strong>Design.—: </strong>A 1-year retrospective analysis of new ASC-H-associated visits to a large colposcopy unit in Ireland in 2022 was performed.</p><p><strong>Results.—: </strong>The incidence of new ASC-H referrals was 3.63% (97 of 2672). The sensitivity of colposcopy for detection of high-grade changes (cervical intraepithelial neoplasia [CIN]2+) is 69.39% (34 of 49) and the specificity is 43.18% (19 of 44). The positive predictive value is 64.15% (34 of 53) and the negative predictive value is 37.50% (15 of 40). High-grade dysplasia was identified in 53.26% (49 of 92) and adenocarcinoma in situ in 2.17% (2 of 92) of cases. Excisional treatment was performed for 52.58% (51 of 97) and cold coagulation for 12.37% (12 of 97). The test-of-cure result was HPV negative for 84.13%. High-risk HPV and abnormal cytology was seen in 9.52% (6 of 63) of cases, thus all required a second test-of-cure smear.</p><p><strong>Conclusions.—: </strong>ASC-H with high-risk HPV has a 55.43% (51 of 92) risk of high-grade dysplasia, thus timely colposcopy and biopsy is imperative. Treatment was curative in 84.13% (53 of 63) to 96.83% (61 of 63) of cases so it is an effective management strategy. Conservative management of selected cases may be a reasonable option.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of pathology & laboratory medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5858/arpa.2024-0423-OA","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Context.—: "Atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion" (ASC-H) cytology is uncommon (0.16%-0.43%). The reported risk of high-grade dysplasia varies hugely (12.00%-70.00%), making management challenging. Primary human papillomavirus (HPV) screening requires an updated understanding of ASC-H.

Objective.—: To review ASC-H colposcopic and histologic comparators, and management outcomes, to help guide future management.

Design.—: A 1-year retrospective analysis of new ASC-H-associated visits to a large colposcopy unit in Ireland in 2022 was performed.

Results.—: The incidence of new ASC-H referrals was 3.63% (97 of 2672). The sensitivity of colposcopy for detection of high-grade changes (cervical intraepithelial neoplasia [CIN]2+) is 69.39% (34 of 49) and the specificity is 43.18% (19 of 44). The positive predictive value is 64.15% (34 of 53) and the negative predictive value is 37.50% (15 of 40). High-grade dysplasia was identified in 53.26% (49 of 92) and adenocarcinoma in situ in 2.17% (2 of 92) of cases. Excisional treatment was performed for 52.58% (51 of 97) and cold coagulation for 12.37% (12 of 97). The test-of-cure result was HPV negative for 84.13%. High-risk HPV and abnormal cytology was seen in 9.52% (6 of 63) of cases, thus all required a second test-of-cure smear.

Conclusions.—: ASC-H with high-risk HPV has a 55.43% (51 of 92) risk of high-grade dysplasia, thus timely colposcopy and biopsy is imperative. Treatment was curative in 84.13% (53 of 63) to 96.83% (61 of 63) of cases so it is an effective management strategy. Conservative management of selected cases may be a reasonable option.

非典型鳞状细胞的结果和处理——在原发性人乳头瘤病毒筛查系统中不能排除高级别鳞状上皮内病变。
上下文。-:“非典型鳞状细胞-不能排除高级别鳞状上皮内病变”(ASC-H)细胞学不常见(0.16%-0.43%)。报道的高级别发育不良的风险差异很大(12.00%-70.00%),使得管理具有挑战性。原发性人乳头瘤病毒(HPV)筛查需要对asc - h有新的认识。-:回顾ASC-H阴道镜和组织学比较,以及治疗结果,以帮助指导未来的治疗。-:对2022年爱尔兰一家大型阴道镜检查单位的新asc - h相关就诊进行了为期1年的回顾性分析。-:新ASC-H转诊的发生率为3.63%(2672例中的97例)。阴道镜检查高度病变(宫颈上皮内瘤变[CIN]2+)的敏感性为69.39%(49例中的34例),特异性为43.18%(44例中的19例)。阳性预测值为64.15%(53 / 34),阴性预测值为37.50%(40 / 15)。92例中有49例(53.26%)发现高度增生,2例(2.17%)发现原位腺癌。切除治疗占52.58%(51 / 97),冷凝治疗占12.37%(12 / 97)。治愈试验HPV阴性占84.13%。9.52%的病例(63例中的6例)存在高危HPV和细胞学异常,因此所有病例都需要进行第二次治愈试验涂片。-: ASC-H合并高危HPV发生高度发育不良的风险为55.43%(51 / 92),因此及时进行阴道镜检查和活检是必要的。治愈率为84.13%(53 / 63)~ 96.83%(61 / 63),是一种有效的治疗策略。对选定病例的保守治疗可能是一个合理的选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信