Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Follow up of Atypical Squamous Cell Pap Smears in Iraqi Women

  • Pity, Intisar S. (Department of Pathology, Faculty of Medicine, University of Duhok) ;
  • Shamdeen, Maida Y. (Department of Pathology, Faculty of Medicine, University of Duhok) ;
  • Wais, Shawnim A. (Department of Pathology, Faculty of Medicine, University of Duhok)
  • Published : 2012.07.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives: To report the prevalence of atypical squamous cells of undetermined significance and atypical squamous cells-cannot exclude high squamous intraepithelial lesions and to determine the possible association of Pap test results with high-risk human papillomavirus and high squamous intraepithelial lesions in women from Duhok, Iraq. Design: A prospective, observational study was conducted between January 2005 and December 2011. Overall, 596 women with a cervicovaginal Pap test showing atypical squamous cells of undetermined significance and 93 atypical squamous cells-cannot exclude high squamous intraepithelial lesion for whom pathologic follow-up was available were studied. Follow-up consisted of repeat cytology, colposcopy and histology. High risk human papillomavirus DNA testing was performed on exfoliated cervical cells from 106 women, using conventional PCR after at least 36 months from the initial Pap smear. Results: Significantly high proportions of both atypical squamous cells of undetermined significance (87.9%) and atypical squamous cells-cannot exclude high squamous intraepithelial lesion (62.4%) demonstrated no significant lesion on subsequent follow up. Low squamous intraepithelial lesions were observed in 1.7% of cases of atypical squamous cells of undetermined significance and in 5.4% of atypical squamous cells-cannot exclude high squamous intraepithelial lesion. High squamous intraepithelial lesion was demonstrated in 0.8% and 16.1% respectively. In the latter there was also one case of invasive carcinoma. High-risk HPV DNA was demonstrated in 40% of atypical squamous cells of undetermined significance and 57.1% of atypical squamous cells-cannot exclude high squamous intraepithelial lesions. Conclusions: Since both atypical squamous cells of undetermined significance and atypical squamous cells-cannot exclude high squamous intraepithelial lesion identify patients who are at an increased risk for the development of high squamous intraepithelial lesions and a considerable percentage harbor high risk-HPV, both should be retained as diagnostic categories and patients warrant a diligent follow up and testing for high risk-HPV DNA. Colposcopic evaluation and biopsy, when indicated, are a must.

Keywords

References

  1. Alli PM, Ali SZ (2003). Atypical squamous cells of undetermined significance-rule out high grade squamous intraepithelial lesion: cytopathologic characteristics and clinical correlates. Diagn Cytopathol, 28, 308-12. https://doi.org/10.1002/dc.10286
  2. ASCUS-LSIL Traige Study (ALTS) Group (2003). Results of a randomized trial on the management of cytology interpretations of atypical squamous cells of undetermined significance. Am J Obstet Gynecol, 188, 1381-2. https://doi.org/10.1067/mob.2003.471
  3. Bandyopadhyay S, Austin M, Dabbs D, Zhao C (2008). Adjunctive human papillomavirus DNA testing is a useful option in some clinical settings for disease risk assessment and triage of females with ASC-H Papanicolaou test results. Arch Pathol Lab Med, 132, 1874-81.
  4. Bansal M, Li Z, Zhao C (2012). Correlation of histopathologic/cytologic follow-up findings with vaginal ASC-US and ASC-H Papanicolaou test and HPV test results. American Journal of Clinical Pathology, 137, 437-43. https://doi.org/10.1309/AJCP9TO1OMXLDDPI
  5. Barcelos ACM, Michelin MA, Adad SJ, Murta EFC (2011). Atypical squamous cells of undetermined significance: Bethesda classification and association with human papillomavirus. Infectious Diseases in Obstetrics and Gynecology, 2011. doi:10.1155/2011/904674.
  6. Barreth D, Schepansky A, Capstick V, et al (2006). Atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H): a result not to be ignored. J Obstet Gynaecol Can, 28, 1095-8.
  7. Chivukula M, Shidham VB (2006). ASC-H in Pap test-definitive categorization of cytomorphological spectrum. CytoJournal, 3, 14. https://doi.org/10.1186/1742-6413-3-14
  8. CytrynI A, Russomano FB, de Camargo MJ, et al (2009). Prevalence of cervical intraepithelial neoplasia grades II/III and cervical cancer in patients with cytological diagnosis of atypical squamous cells when high-grade intraepithelial lesions (ASC-H) cannot be ruled out. Sao Paulo Med J, 127, 283-7. https://doi.org/10.1590/S1516-31802009000500007
  9. De Roda Husman A, Walboomers JMM, van den Brule AJC, et al (1995). The use of general primers GP5 and GP6 elongated at their 3' ends with adjacent highly conserved sequences improves human papillomavirus detection by PCR. Journal of General Virology, 76, 1057-62. https://doi.org/10.1099/0022-1317-76-4-1057
  10. Duncan LD, Jacob SV (2005). Atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion: The practice experience of a hospital-based reference laboratory with this new Bethesda system diagnostic category. Diagnostic Cytopathol, 32, 243-6. https://doi.org/10.1002/dc.20227
  11. Gerber S, De Grandi P, Petignat P, Mihaescu A (2001). Colposcopic evaluation after a repeat atypical squamous cells of undetermined significance (ASCUS) smear. Int J Gynaecol Obstet, 75, 251-5. https://doi.org/10.1016/S0020-7292(01)00479-9
  12. Ghaemmaghami F, Ensani F, Behtash N, Hosseini-Nejad E (2005). Pap smear with atypical squamous cells of undetermined significance. Arch Iranian Med, 8, 192-6.
  13. Jacobs MV, Snijders PJ, van den Brule AJ, et al (1997). A general primer GP5+/GP6(+)-mediated PCR-enzyme immunoassay method for rapid detection of 14 high-risk and 6 low-risk human papillomavirus genotypes in cervical scrapings. J ClinMicrobiol, 35, 791-5.
  14. Kaygusuz EI, CetIner H, SahIn D (2011). LSIL/ASC-H (LSIL-H) in cervicovaginal smear: Histopathological outcomes and clinical significance. TJPath, 27, 45-50.
  15. Lee SJ, Song SY, Kim BG, Lee Park JH, Bae CSDS (2006). Analyses of atypical squamous cells refined by the 2001 Bethesda System: the distribution and clinical significance of follow-up management. Int J Gynecol Can, 16, 664-9. https://doi.org/10.1111/j.1525-1438.2006.00403.x
  16. Louro AP, Roberson J, Eltoum I, Chhieng DC (2003). Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion. A Follow-up study of conventional and liquid-based preparations in a high-risk population. Am J Clin Pathol, 120, 392-7. https://doi.org/10.1309/NPU3WRQCTAB81XLW
  17. Manos MM, Kinney WK, Hurley LB, et al (1999). Identifying women with cervical neoplasia: using human papillomavirus DNA testing for equivocal Papanicolaou results. JAMA, 281, 1605-10. https://doi.org/10.1001/jama.281.17.1605
  18. Michelow P, Hartman I, Schulze D, et al (2010). Atypical squamous cells, cannot exclude high grade squamous intraepithelial (ASC-H) in HIV-positive women. Cytojournal, 7, 8. https://doi.org/10.4103/1742-6413.64376
  19. Mood NI, Haratian A (2004). Atypical squamous cells of undetermined significance: A cytohistologic study. Acta Medica Iranica, 42, 295-9.
  20. Murta EFC, Silva CS, Vieira JB, Khabbaz KM, Adad SJ (2007). Cervical neoplasia after diagnosis and follow-up of women with atypical squamous cells of undetermined significance. Clin Exp Obstet Gynecol, 34, 219-22.
  21. NCI Bethesda System 2001 (2001). Bethesda system for reporting results of cervicovaginal cytologic disease. Available at: http://www.Bethesda2001.cancer.gov.
  22. Roche D, Spicer N (2001). The clinical significance of atypical squamous cells of undetermined significance: a laboratory audit of cervical reporting. N Z Med J, 114, 64-6.
  23. Saad RS, Dabbs DJ, Kordunsky L, et al (2006). Clinical significance of cytologic diagnosis of atypical squamous cells, cannot exclude high grade, in perimenopausal and postmenopausal women. Am J Clin Pathol, 126, 381-8. https://doi.org/10.1309/XVB01JQYQNM7MJXU
  24. Selvaggi SM (2003). Reporting of atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion (ASC-H) on cervical samples: is it significant? Diagn Cytopathol, 29, 38-41. https://doi.org/10.1002/dc.10303
  25. Sherman ME, Solomon D, Schiffman M (2001). Qualification of ASCUS a comparison of equivocal LSIL and equivocal HSIL cervical cytology in the ASCUS LSIL Triage Study. Am J Clin Pathol, 116, 386-94. https://doi.org/10.1309/JM3V-U4HP-W8HJ-68XV
  26. Sherman ME, Castle PE, Solomon D (2006). Cervical cytology of atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H). Cancer, 108, 298-305. https://doi.org/10.1002/cncr.21844
  27. Solomon D, Schiffman M, Tarone (2001). Comparison of three management strategies for patients with atypical squamous cells of undetermined significance: Baseline results from a randomized trial. JNCI, 93, 293-9. https://doi.org/10.1093/jnci/93.4.293
  28. Srodon M, Parry DH, Ronnett BM (2005). Atypical squamous cells, cannot exclude high grade squamous intraepithelial lesion: diagnostic performance, human papillomavirus testing and follow up results. Cancer, 108, 32-8. https://doi.org/10.1002/cncr.21388
  29. Tewari LCR, Chaudhary CA (2010). Atypical Squamous Cells of Undetermined Significance: A Follow up Study. MJAFI, 66, 225-7.
  30. Van den Brule AJ, Pol R, Fransen-Daalmeijer N, et al (2002). GP5+/6+ PCR followed by reverse line blot analysis enables rapid and high-throughput identification of human papillomavirus genotypes. J Clin Microbiol, 40, 779-87. https://doi.org/10.1128/JCM.40.3.779-787.2002
  31. Youens KE, Hosler GA, Washington PJ, Jenevein EP, Murphy KM (2011). Clinical Experience with the Cervista HPV HR Assay. J Mol Diagn, 13, 160-6. https://doi.org/10.1016/j.jmoldx.2010.11.016
  32. Zhao C, Zhao S, Heider A, Austin RM (2010). Significance of high-risk human papillomavirus DNA detection in women 50 years and older with squamous cell Papanicolaou test abnormalities. Archives of Pathology & Laboratory Medicine, 134, 1130-5.

Cited by

  1. Reliability of Colposcopy in Turkey: Correlation with Pap Smear and 1-year Follow Up vol.15, pp.17, 2014, https://doi.org/10.7314/APJCP.2014.15.17.7317
  2. Clinical management of the first ASCUS report in Chile. Prospective single-cohort study vol.133, pp.6, 2015, https://doi.org/10.1590/1516-3180.2014.9142511