Williams M L, Rimm D L, Pedigo M A, Frable W J
Department of Pathology, Virginia Commonwealth University, Medical College of Virginia, Richmond 23298-0115, USA.
Diagn Cytopathol. 1997 Jan;16(1):1-7. doi: 10.1002/(sici)1097-0339(199701)16:1<1::aid-dc2>3.0.co;2-m.
The diagnosis of ASCUS (atypical squamous cells of undetermined significance) was introduced in the 1988 Bethesda System for reporting cervical/vaginal cytologic findings. Outcome and appropriate management of patients with this diagnosis is not presently established. Criteria defining ASCUS are nuclear enlargement (2.5-3.0 times normal intermediate cell nucleus), mild nuclear hyperchromasia, smooth nuclear outlines with mild variation in nuclear size and shape, or else two, but not all three, cytologic criteria for human papilloma virus (HPV) cytopathic effect. All 668 cases reported as ASCUS from February 1992-December 1993 from our cytology laboratory were reviewed. These ASCUS cases represented 4.5% of all gynecologic cases diagnosed in that same time period. Of these, 284 (41%) had a subsequent colposcopic biopsy and/or endocervical curettage. The biopsied cases included 101 (36%) with condylomata, 38 (13%) with cervical intraepithelial neoplasia (CIN) I, 17 (6%) with CIN II, and 9 (3%) with CIN III. No cases of carcinoma were detected. Of patients with a cytologic diagnosis of ASCUS and subsequent cervical biopsy, 49% had low-grade cervical intraepithelial neoplasia (LGSIL), either condyloma or CIN I. Nine percent had high-grade cervical intraepithelial neoplasia, either CIN II or CIN III. These findings indicate that ASCUS defines cytologically a group of patients who may have either a concurrent or subsequent development of a squamous intraepithelial lesion (SIL). This forms a high-risk group. The management of cases with a cytologic diagnosis of ASCUS should be at least as aggressive as that of LGSIL.
非典型鳞状细胞意义不明确（ASCUS）的诊断是在1988年的贝塞斯达系统中引入的，用于报告宫颈/阴道细胞学检查结果。目前尚未确定该诊断患者的结局及适当管理方法。定义ASCUS的标准为细胞核增大（为正常中层细胞核的2.5 - 3.0倍）、轻度核深染、核轮廓光滑且核大小和形状有轻度变化，或者具备人乳头瘤病毒（HPV）细胞病变效应的两条但非全部三条细胞学标准。对1992年2月至1993年12月期间我们细胞学实验室报告为ASCUS的所有668例病例进行了回顾。这些ASCUS病例占同一时期诊断的所有妇科病例的4.5%。其中，284例（41%）随后进行了阴道镜活检和/或宫颈管刮术。活检病例包括101例（36%）尖锐湿疣、38例（13%）宫颈上皮内瘤变（CIN）I级、17例（6%）CIN II级和9例（3%）CIN III级。未检测到癌病例。在细胞学诊断为ASCUS并随后进行宫颈活检的患者中，49%患有低级别宫颈上皮内瘤变（LGSIL），即尖锐湿疣或CIN I级。9%患有高级别宫颈上皮内瘤变，即CIN II级或CIN III级。这些发现表明，ASCUS在细胞学上定义了一组可能同时或随后发生鳞状上皮内病变（SIL）的患者。这构成了一个高危组。对细胞学诊断为ASCUS的病例的管理应至少与LGSIL一样积极。
