Department of Pathology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
Eur J Obstet Gynecol Reprod Biol. 2011 Nov;159(1):155-9. doi: 10.1016/j.ejogrb.2011.05.022. Epub 2011 Jun 17.
Despite the usefulness of Pap tests for cancer screening, outcomes can be difficult to predict when atypical squamous cells (ASCs) are identified. According to the 2001 Bethesda system, ASCs can be subdivided into two groups: ASCs of undetermined significance (ASC-US); and ASCs, cannot exclude high-grade squamous intra-epithelial lesion (ASC-H). ASC-H interpretations are uncommon, and studies involving this type of lesion are based on small numbers of cases.
Cross-sectional, retrospective study of 392 ASC-H cases. The follow-up outcomes of ASC-H cases that were diagnosed during routine primary screening between 2002 and 2008 were investigated, and relationships between clinicopathological parameters were assessed, particularly positive test for high-risk HPV (HPV) DNA, patient age at diagnosis and previous abnormal cytology.
Of the 392 cases, high-grade squamous intra-epithelial lesion (HSIL) was detected in 111 (28.3%) cases, squamous cell carcinoma was detected in 15 (3.8%) cases, low-grade squamous intra-epithelial lesion was detected in 37 (9.4%) cases, reactive change was detected in 178 (45.4%) cases, atrophy was detected in 47 (12.0%) cases, and adenocarcinoma was detected in four (1.0%) cases. The prevalence of HSIL or greater was 27.8% for women aged ≥ 40 years, and 52.3% for women aged <40 years (p<0.001). HPV positivity in ASC-H smears was significantly associated with HSIL or greater, irrespective of age (<40 years, p=0.003; ≥ 40 years, p<0.001). ASC-H with previous abnormal cytology greater than ASC-US showed a significantly higher detection rate for HSIL or greater at follow-up (p<0.001).
Patient age, positive HPV DNA test and previous abnormal cytology are useful predictors of underlying HSIL or greater in women with ASC-H.
巴氏涂片检查虽然对癌症筛查有用，但当发现非典型鳞状细胞（ASC）时，结果可能难以预测。根据 2001 年的巴氏系统，ASC 可分为两组：意义不明确的非典型鳞状细胞（ASC-US）；不能排除高级别鳞状上皮内病变（ASC-H）。ASC-H 解读并不常见，涉及这种病变的研究基于少数病例。
对 2002 年至 2008 年期间在常规初级筛查中诊断为 ASC-H 的 392 例 ASC-H 病例进行横断面、回顾性研究。调查 ASC-H 病例的随访结果，并评估临床病理参数之间的关系，特别是高危型 HPV（HPV）DNA 阳性检测、诊断时患者年龄和以前的异常细胞学。
在 392 例病例中，111 例（28.3%）发现高级别鳞状上皮内病变（HSIL），15 例（3.8%）发现鳞状细胞癌，37 例（9.4%）发现低级别鳞状上皮内病变，178 例（45.4%）发现反应性改变，47 例（12.0%）发现萎缩，4 例（1.0%）发现腺癌。≥40 岁的女性 HSIL 或更高级别病变的患病率为 27.8%，<40 岁的女性患病率为 52.3%（p<0.001）。无论年龄大小（<40 岁，p=0.003；≥40 岁，p<0.001），ASC-H 涂片 HPV 阳性与 HSIL 或更高级别病变显著相关。ASC-H 伴以前异常细胞学大于 ASC-US 时，在随访时发现 HSIL 或更高级别病变的检出率显著更高（p<0.001）。
患者年龄、HPV DNA 检测阳性和以前的异常细胞学是 ASC-H 患者潜在 HSIL 或更高病变的有用预测指标。
