Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY.
Am J Clin Pathol. 2020 Sep 8;154(4):553-558. doi: 10.1093/ajcp/aqaa069.
To evaluate the impact of implementing the dual interpretation of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) and low-grade squamous intraepithelial lesion (LSIL) after the Bethesda System 2014 and to compare it with other indeterminate interpretations.
Rates of high-risk human papillomavirus (HPV) positivity and histologic follow-up and the proportion of women with high-grade squamous intraepithelial lesion on histologic follow-up were compared for the combined interpretation of ASC-H and LSIL (ASCHL) and the categories of LSIL, cannot exclude high-grade squamous intraepithelial lesion (LSIL-H) and ASC-H.
The percentage of ASCHL HPV-positive cases (86.0%) was similar to that of LSIL-H but significantly higher in comparison to that of ASC-H. The rates of cervical intraepithelial neoplasia grade 2 or higher (CIN 2+) and CIN 3+ for ASCHL (29.6% and 3.6%, respectively) were similar to those of LSIL-H and ASC-H. When stratified by HPV test results, the proportions of patients with CIN 2+ and CIN 3+ remained statistically similar to those with ASCHL and with LSIL-H and ASC-H.
Considering the similar risks of CIN 2+ and CIN 3+ for ASCHL and ASC-H, having a separate category of ASCHL for reporting cervical cytology appears to be redundant.
评估在 2014 年巴氏系统实施不典型鳞状细胞的双重解释，不能排除高级别鳞状上皮内病变（ASC-H）和低级别鳞状上皮内病变（LSIL）后的影响，并将其与其他不确定解释进行比较。
比较 ASC-H 和 LSIL（ASCHL）联合解释与 LSIL、不能排除高级别鳞状上皮内病变（LSIL-H）和 ASC-H 类别之间高危型人乳头瘤病毒（HPV）阳性率、组织学随访率以及组织学随访中高级别鳞状上皮内病变患者的比例。
ASCHL HPV 阳性病例的百分比（86.0%）与 LSIL-H 相似，但明显高于 ASC-H。ASCHL 的宫颈上皮内瘤变 2 级或更高级别（CIN 2+）和 CIN 3+的发生率（分别为 29.6%和 3.6%）与 LSIL-H 和 ASC-H 相似。当按 HPV 检测结果分层时，CIN 2+和 CIN 3+的患者比例与 ASCHL 和 LSIL-H 和 ASC-H 相比仍然具有统计学意义。
考虑到 ASCHL 和 ASC-H 的 CIN 2+和 CIN 3+的风险相似，为报告宫颈细胞学检查而单独设立 ASCHL 类别似乎是多余的。
