Clinical Implications of the Diagnosis "Atypical Squamous Cells, Cannot Exclude High-grade Squamous Intraepithelial Lesion" in Pregnant Women.
From: Department of Pathology, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. kzyonm@nifty.com
Cancer
- Publish Date: Oct 2006
- ISSN: 0008-543X
- Volume: 108
- Issue: 5
- Pages: 282-7
- Medium: Print
- Language: English
- Citation (JAMA): Onuma Kazuya, Saad Reda S, Kanbour-Shakir Amal, et al. Clinical Implications of the Diagnosis "Atypical Squamous Cells, Cannot Exclude High-grade Squamous Intraepithelial Lesion" in Pregnant Women.. Cancer Oct 2006;108:282-7
Abstract
BACKGROUND: Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) has a high predictive value for high-grade intraepithelial lesion (HSIL) in the general population. However, the significance of ASC-H in pregnant women remains to be elucidated. The objective of this study was to investigate the clinical implications and pathologic significance of ASC-H in pregnant women, so that these patients will be managed appropriately. METHODS: All Papanicolaou tests that were diagnosed as ASC-H in pregnant women over 1.5 years (total, 60 women) were reviewed and correlated with histologic and/or cytologic follow-up. High-risk type of human papillomavirus (HPV) status was also correlated with follow-up findings. The following cytomorphologic parameters were evaluated for each woman and were compared between the squamous intraepithelial lesion (SIL) follow-up group and the benign follow-up group: inflammatory background, the number of atypical cells, cell arrangement pattern, nuclear irregularity/grooves, hyperchromasia, and cell shape. RESULTS: Among 30 women who had histologic follow-up, 3 women (10%) had HSIL, and 13 women (43%) had low-grade intraepithelial lesion (LSIL). Among 32 women who had cytologic follow-up, 2 women (6%) had HSIL, 3 women (9%) had LSIL, 1 woman (3%) had ASC-H, and 3 women (9%) had atypical squamous cells of undetermined significance (ASCUS). HPV was detected in 24 of 43 women (56%). The cytomorphologic features were similar in the SIL follow-up group and the benign follow-up group. No specific cytomorphologic features that predicted underlying SIL were identified. CONCLUSIONS: ASC-H in pregnant women had a lower predictive value for an underlying HSIL compared with the general population. A positive HPV test result was not a good indicator for an underlying SIL, but a negative result appeared to be useful for ruling out an underlying HSIL. Because of low positive predictive value for HSIL and the difficult colposcopic examination, a more conservative follow-up may be reasonable for pregnant women who have a diagnosis of ASC-H. HPV testing may be used as an adjunctive test.
Mesh Headings (Keywords): Adolescent, Adult, Cervical Intraepithelial Neoplasia, Female, Humans, Neoplasms, Squamous Cell, Papillomavirus Infections, Predictive Value of Tests, Pregnancy, Pregnancy Complications, Risk Factors, Tumor Virus Infections, Uterine Cervical Neoplasms, Vaginal Smears
Check for Full Text / PubMed Unique Identifier (PMID): 16991139
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