Laboratory and clinical characterization of monoclonal gammopathy in Taiwanese.

BACKGROUND AND PURPOSE: To investigate the prevalence of monoclonal gammopathy, the frequency of associated diseases, and the laboratory features useful in the differential diagnosis and prediction of associated complications. MATERIALS AND METHODS: From January 1994 through December 1998, 11,510 serum samples and 1,555 urine samples from 10,974 Taiwanese patients requiring electrophoresis study were examined for the presence of monoclonal protein by electrophoresis on cellulose acetate membrane and immunofixation electrophoresis (IFE). RESULTS: Two hundred and eighty seven cases (2.6%) of monoclonal gammopathy were found. Of these, 136 (47.4%) had multiple myeloma, 84 (29.3%) had monoclonal gammopathy of undetermined significance (MGUS), 53 (18.5%) had other lymphoproliferative disorders (LPD), eight (2.8%) had polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin pigmentation (POEMS) syndrome, and six (2.1%) had cryoglobulinemia. Immunoglobulin A (IgA) monoclonal protein was more often associated with myeloma than LPD (25 vs 3.8%, p = 0.002); monoclonal light chains were more often associated with myeloma than MGUS (17% vs 3.6%, p = 0.006). Biclonal gammopathy was more often associated with MGUS than myeloma (10.7 vs 1.5%, p = 0.014). Hypogammaglobulinemia was common in patients with myeloma (70%) but rare in patients with LPD (20%, p < 0.001) and in those with MGUS (5%, p < 0.001). Concomitant polyclonal hypergammaglobulinemia was rare in patients with myeloma (5%), but common in patients with LPD (53%, p < 0.001) or MGUS (27%, p < 0.001). Patients with lambda chain myeloma had the highest risk (100%) of developing renal insufficiency. Our myeloma patients were also at increased risk of developing myelomatous pleural effusions than previously reported. CONCLUSIONS: The lower frequency of MGUS in this study than previously reported may have been due to differences in patient selection, laboratory methods, and the presence of local diseases. The presence of POEMS syndrome and cryoglobulinemia, the very high association of lambda chain myeloma with renal failure, and the higher occurrence of myelomatous effusion than previously reported probably reflected local disease patterns.     

宫颈细胞学检查为ASCUS的临床意义及处理探讨

目的:探讨宫颈细胞学检查为ASCUS(不典型鳞状细胞-意义不明)的临床意义和处理方法。方法:2005年3月至2007年9月,对上海市第十人民医院妇科就诊的218例细胞学检查报告为ASCUS患者行阴道镜评估与镜下活检,其中100例患者同时进行了高危HPV-DNA检测。结果:218例ASCUS患者中宫颈上皮内瘤变(CIN)的发生率为49.54%,高级别CIN及浸润癌的发生率为17.43%,阴道镜拟诊≥CINⅡ40例,与病理结果相符29例,符合率72.5%(29/40)。高危HPV阳性组CIN检出率为66.67%,明显高于阴性组的36.96%。高级别CIN(CINⅡ、CINⅢ)17例中16例高危HPV-DNA检测阳性,仅1例CINⅡ为阴性。鳞癌3例,高危HPV检测均为阳性。结论:细胞学报告为AS-CUS时,阴道镜下病理活检结果相差大,而且可能是发现高度CIN的第一个信号,需引起重视。高危HPV-DNA检测是一种有效的ASCUS分流管理手段,能提高CIN的检出率。     

Atypical glandular cells of undetermined significance. Review of final histologic diagnoses

OBJECTIVE: To review recent literature that examines the histologic characterization of women with atypical glandular cells of undermined significance (AGUS) on a Pap smear. STUDY DESIGN: The English-language literature published between January 1995 and April 2000 was reviewed. The MEDLINE database and the search terms atypical glandular cells of undetermined significance and AGUS were used. The references cited in the studies were reviewed to identify additional publications. Studies that reported data from patients with a cytologic diagnosis of AGUS without an associated squamous lesion identified by Pap smear were used to summarize the final histologic diagnoses. RESULTS: Eight percent of women with the diagnosis of an AGUS Pap smear without a concurrent squamous lesion had a malignancy. CONCLUSION: A thorough initial evaluation is recommended for all women with a cytologic diagnosis of AGUS.     

Atypical glandular cells of undetermined significance. Histologic findings and proposed management

OBJECTIVE: To increase understanding of the clinical significance of atypical glandular cells of undetermined significance (AGUS) on cervical cytology and to suggest a management plan. STUDY DESIGN: All Pap smears classified as AGUS over a period of five years at the University of Michigan Medical Center were reviewed and the diagnosis confirmed. The charts of these patients were reviewed for demographics, significant previous medical history, symptoms, diagnostic studies performed and final histologic diagnoses. RESULTS: In 1993-1998, a total of 208,041 Pap smears were read. Two hundred seven smears from 189 patients were classified as AGUS, for an incidence of 0.1%. There were 136 patients with follow-up information and 114 patients with histologic diagnoses. In 55 of the 114 patients (48%), significant histologic abnormalities were observed, including 11 endometrial cancers, 1 invasive adenocarcinoma of the cervix, 3 adenocarcinomas in situ of the cervix, 18 CIN 3 lesions and 5 CIN 2 lesions. Among 20 patients with Pap smears subclassified as "atypical glandular cells of undetermined significance, favor benign process," there were two CIN 2, five CIN 3 and one adenocarcinoma in situ of the cervix. CONCLUSION: A diagnosis of AGUS requires an aggressive workup because of the high rate of cancer and precancerous lesions. The evaluation, at the very least, should include colposcopy with directed biopsies and endocervical curettage. Postmenopausal patients, those with irregular bleeding and those with high risk characteristics should also undergo endometrial biopsy.     

Atypical glandular cells of undetermined significance. Subtyping as a predictor of outcome

OBJECTIVE: To determine whether subtyping of atypical glandular cells of undetermined significance (AGUS) cervical smears into reactive process favored (AGUS-RPF) and not otherwise specified (AGUS-NOS) correlates with rates of underlying pathology. STUDY DESIGN: We performed a retrospective chart review of 129,676 routine Pap smears at Kaiser Permanente, San Diego, from June 1998 to November 1999. One hundred fifty of the 129,676 were evaluated as AGUS (0.12%). Subjects with concomitant AGUS/SIL Pap smears, a prior history surgery for dysplasia, prior AGUS, a history of cancer or prior hysterectomy were excluded from the study. The remaining AGUS smears were then subtyped into AGUS-NOS and AGUS-RPF based on the criteria of the 2nd Workshop of the Bethesda System. Sixty-eight subjects with an initial AGUS smear underwent evaluation with colposcopy, endocervical curettage, endometrial biopsy and directed cervical biopsies. Significant pathology was determined to be any tissue diagnosis that required further treatment more than a follow-up Pap smear. AGUS subclassifications and underlying pathology were then compared using the chi 2 test with Fisher's Exact Test. RESULTS: Twenty-seven patients (40%) had AGUS-NOS, and 41 (60%) had AGUS-RPF. There were no significant differences between the groups in regard to age, race, parity, menopause status, HRT use or tobacco use. CONCLUSION: Subtyping AGUS cervical smears correlates with underlying rates of pathology. However, AGUS-RPF smears were still associated with an approximately 10% incidence of significant underlying pathology. Patients with AGUS on cervical smears need thorough evaluation, regardless of subtyping.     

Clinical evaluation of atypical glandular cells of undetermined significance

OBJECTIVE: This study was undertaken to determine the clinical implications of the finding of atypical glandular cells of undetermined significance in cervical cytologic specimens in our patient population. STUDY DESIGN: A retrospective study was performed. All cervical cytologic examinations with the diagnosis of atypical cells of undetermined significance between January 1992 and June 1997 were identified by means of a computerized database. Medical records were reviewed to identify patient demographic characteristics and to determine the presence or absence of associated pathologic conditions of the cervix and endometrium. The chi2 test and analysis of variance were applied to dichotomous and continuous variables, respectively, to determine the implications of a cytologic evaluation of atypical glandular cells of undetermined significance. RESULTS: Cytologic results reported as atypical glandular cells of undetermined significance were obtained in a patient cohort of 492. Atypical glandular cells of undetermined significance was the only cytologic diagnosis in 224 patients; 268 patients had both atypical glandular cells of undetermined significance and an additional squamous abnormality, including atypical squamous cells of undetermined significance and cervical intraepithelial neoplasia I, II, or III. Two patients were excluded because of a history of endometrial cancer. A histologic evaluation was obtained within 1 year in 353 cases. Among the 353 patients who had a histologic evaluation performed, 227 (64%) had benign cervical and endometrial findings. There were 18 glandular lesions (5%), including complex hyperplasia with atypia, adenocarcinoma in situ of the cervix, adenocarcinoma of the cervix, and adenocarcinoma of the endometrium. A squamous lesion was present in 108 patients (31%). Most squamous lesions (81%) were found in patients with atypical glandular cells of undetermined significance associated with a squamous abnormality, whereas only 19% were found in patients with atypical glandular cells of undetermined significance as the only diagnosis. Women <35 years old had a much higher frequency of histologic abnormalities than did women >50 years old (P <.0001), with most of these lesions being squamous. Women >50 years old had a much higher frequency of glandular histologic abnormalities (P <.001). CONCLUSION: More than a third of women with Papanicolaou smears reported as showing atypical glandular cells of undetermined significance will be found to have a histologic abnormality. Women <35 years old with a cytologic evaluation of atypical glandular cells of undetermined significance have a higher frequency of histopathologic findings, with most being squamous lesions. Women with a cytologic evaluation of atypical glandular cells of undetermined significance who are >50 years old have more glandular lesions than do younger women. The term atypical glandular cells of undetermined significance is a misnomer. The significance of this cytologic finding has been defined and represents a marker for serious pathologic processes.     

Clinical significance of a cytologic diagnosis of atypical glandular cells of undetermined significance

OBJECTIVE: To assess the clinical significance of a cytologic diagnosis of atypical glandular cells of undetermined significance (AGUS) and determine the most appropriate evaluation of these patients. STUDY DESIGN: Between 1993 and 1995, 44,217 Papanicolaou smears were evaluated at Allegheny University Hospitals, Medical College of Pennsylvania Campus. There were 108 (0.24%) cases of AGUS smears during that time. No clinical information was available for 14 patients, and 19 were lost to follow-up. The charts of the remaining 75 cases were retrospectively reviewed. RESULTS: Tissue specimens were available for 62 of the 75 patients. There were 26 (42%) with no significant histopathologic findings, 13 (21%) with polyps, 5 (8%) cases of endometrial hyperplasia, 2 (3%) with endometrial adenocarcinoma, 12 (19%) with cervical intraepithelial neoplasia (CIN), 1 (2%) with adenosquamous carcinoma of the cervix, 2 (3%) with cervical adenocarcinoma in situ and 1 (2%) case of metastatic breast cancer. The total number of patients with significant histopathology other than polyps was 23 (37%). The median age of the patients was 49 years. There were more cases of endometrial hyperplasia and endometrial cancer (19%) in women 49 years or older than in younger women; only one (3%) case of endometrial hyperplasia was detected in the younger age group (P = .057). Patients who underwent more-aggressive evaluation (colposcopy and biopsies plus endometrial sampling, cone biopsy or hysterectomy) had greater numbers of abnormal histopathologic findings (55%) than patients who underwent endometrial sampling only (21%) or those who underwent colposcopy and biopsy only (33%). This difference approaches statistical significance (P = .057). A significant proportion of patients with a history of CIN and a cytologic diagnosis of AGUS were found to have CIN (47%), while 8% of those with no history of CIN were found to have CIN (P = .002). Fifty percent of patients with a history of cancer (all had breast cancer) and AGUS had abnormal histopathology. Patients with a subclassification of AGUS "favor neoplasia" had a greater proportion of significant histopathology (72%) as compared to AGUS "unspecified" (26%) and AGUS "favor reactive" (20%) (P = .003). CONCLUSION: A significant proportion of women with a cytologic diagnosis of AGUS have abnormal histopathology. Heightened awareness should be raised in patients with AGUS and a history of CIN or cancer and in those with the AGUS subclassification "favor neoplasia."     

阴道镜检查在宫颈细胞学ASCUS分流管理中的应用

目的探讨电子阴道镜检查在宫颈细胞学意义未明的不典型鳞状细胞(atypical squamous cell of undeter-mined significance,ASCUS)分流管理中的临床应用价值。方法对2006年7月至2008年7月在天津医科大学第二医院门诊行宫颈液基细胞学检查(TCT)结果为ASCUS的471例患者进行电子阴道镜检查,其中203例阴道镜诊断为宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)及以上病变者在可疑病变区取活检送病理检查;268例阴道镜检查为正常或慢性宫颈炎者给予阴道用药治疗1~3个疗程,3个月后复查宫颈涂片,4例细胞学仍异常者行阴道镜下取活检送病理检查,余264例细胞学阴性者定期复查宫颈细胞学。结果471例宫颈细胞学AS-CUS患者中,共行活体组织病理学检查207例(43.95%),检出宫颈上皮内瘤样病变(CINⅠ~Ⅲ)131例,宫颈癌4例,余264例避免了宫颈活检损伤,随访6~30个月复查宫颈细胞学均未发现异常。结论电子阴道镜结合宫颈细胞学检查可有效检出宫颈细胞学ASCUS中CIN及宫颈癌患者,可作为基层医院对ASCUS进行有...     

Atypical squamous cells of undetermined significance (ASCUS): clinical-cytological significance

Abstract. Lambert B, Boivin Y, Lepage Y. Atypical squamous cells of undetermined significance (ASCUS): clinical–cytological significance.
The objective of this paper is to compare histologic results of microbiopsies and/or endocervical curettage obtained following the older cytological "atypical" diagnosis and the newer Bethesda ASCUS terminology. We reviewed a series of atypical smears ( n = 245) from December 1991 to February 1995 and ASCUS cases ( n = 120) from March 1995 to May 1996, when some atypias were renamed ASCUS according to the Bethesda classification. These patients were examined by colposcopy for cervical lesion and clinical evaluation.
Menopausal women were underrepresented in atypical smears ( n = 21/245, 8.6%) in comparison with ASCUS ( n = 29/120, 24.2%, P = 0.001). Since, no low or high grade squamous intraepithelial lesion (L/HSIL) was ever found in the ≥ 50 years group, we reviewed only patients under 50 years. Atypical smears resulted in 61/224 (27.2%) positive biopsies of which 47 (21%) were LSIL and 14 (6.2%) were HSIL; ASCUS smears yielded 17/91 (18.7%) positive pathology diagnoses with 13 (14.3%) LSIL and 4 (4.4%) HSIL. Endocervical curettage positivity (ECC) was at 6/109 (5.5%) for atypias, and 1/53 (1.9%) for ASCUS.
Cervical biopsies in ASCUS smears show a tendency to a lower histologic positivity rate, in comparison with atypical cytology. Persistent ASCUS smears should be evaluated by colposcopy, and thereafter at 6-month intervals. The exact meaning of ASCUS, in spite of a 17.5% CIN rate, remains unknown, but constitutes a high-risk group.     

Human papillomavirus triage for young women with atypical squamous cells of undetermined significance

OBJECTIVE: Human papillomavirus testing is a cost-effective strategy for the management of atypical squamous cells of undetermined significance. Young women have a high prevalence of transient human papillomavirus infections and low incidence high-grade cervical lesions, which may limit the usefulness of human papillomavirus testing in this cohort. We sought to estimate the usefulness of human papillomavirus testing for young women with atypical squamous cells of undetermined significance. METHODS: A retrospective study of women with atypical squamous cells of undetermined significance was undertaken. Reflex human papillomavirus results and pathologic follow-up were evaluated. Age-stratified rates of human papillomavirus positivity, rates of high-grade dysplasia, and sensitivity and specificity were estimated. RESULTS: A total of 1,290 women with atypical squamous cells of undetermined significance cytology were identified. The rate of human papillomavirus positivity decreased with age from 55% for those aged 25 years or younger to 12% for women aged older than 50 years (P < .001). The cumulative rate of high-grade lesions increased with age; 12% for patients aged 25 years or younger compared with 24% for women aged older than 50 years (P = .05). A negative human papillomavirus test more effectively excluded high-grade disease in the young women. No high-grade lesions were detected in the human papillomavirus negative women aged 25 years or younger compared with 3.8% of those aged older than 50 years (P = .04). The sensitivity for detection of high-grade disease was higher in women aged younger than 25 years compared with those aged older than 50 years (100% compared with 50%), whereas specificity was lower (14% compared with 44%). CONCLUSION: Given the high prevalence of human papillomavirus and low occurrence of high-grade lesions in young women with atypical squamous cells of undetermined significance, a human papillomavirus-based triage strategy will result in the referral of a large number of women for colposcopy and may limit its cost-effectiveness. LEVEL OF EVIDENCE: III.     

Atypical squamous cells of undetermined significance. Clinical experience in a Turkish university hospital

OBJECTIVE: To assess the significance of atypical squamous cells of undetermined significance (ASCUS) in predicting the presence of underlying squamous intraepithelial lesion (SIL) of the uterine cervix, and to determine the best follow-up method for these patients. STUDY DESIGN: We reviewed 76 cases with cervical smears that had been labeled ASCUS over a 41-month period, 64 of which were also examined colposcopically. RESULTS: The 76 reported ASCUS cases represented 1.2% of all gynecologic cases diagnosed at our center during the same time period. Of the 64 patients who underwent colposcopy, 9 (14%) had low-grade SIL and 7 (11%) had high-grade SIL. CONCLUSION: Based on this study, ASCUS on a cervical smear is a good marker for detecting underlying SIL, and immediate colposcopy and directed biopsy are the most appropriate follow-up procedures.     

Atypical squamous cells of undetermined significance in girls and women

OBJECTIVE: To estimate the outcome of adolescents with atypical squamous cells of undetermined significance (ASC-US) on cytology. METHODS: A review of ASC-US cytology in girls and women aged 10-19 years between 1995 and 1999 was performed. The cytologic and histologic follow-up of each patient was evaluated. The outcome was recorded as the most significant (highest grade) subsequent cervical smear or biopsy. RESULTS: Overall, 535 of 7897 (6.8%) cervical cytologic specimens were reported as ASC-US. The study group consisted of 398 patients for whom pathologic follow-up was available. The mean duration of follow-up was 19 months. Follow-up consisted of repeat cytology in 251 (63%) patients and colposcopy with cervical biopsies and/or endocervical curettage in 147 (37%) of the adolescents. Two hundred fifty-three (64%) adolescents had no pathologic abnormalities on follow-up. Persistent ASC-US was identified in 65 (16%), low-grade squamous intraepithelial lesions/cervical intraepithelial neoplasia (CIN) 1 was found in 44 (11%) and high-grade squamous intraepithelial lesions/CIN 2 or 3 occurred in 36 (9%) of the adolescents. No cases of invasive carcinoma were found. CONCLUSIONS: Among adolescents with ASC-US, the rate of squamous intraepithelial lesions/CIN is similar to that of adults. Although the optimal management of ASC-US in adolescents is unknown, these patients warrant close follow-up. LEVEL OF EVIDENCE: III     

Atypical glandular cells of undetermined significance in cervical cytologic findings

OBJECTIVE: Our purpose was to increase our understanding of the clinical significance of atypical glandular cells of undetermined origin. STUDY DESIGN: All cytologic Papanicolaou smears were reviewed and classified within the context of the Bethesda classification system. Charts of all patients with a diagnosis of atypical glandular cells of undetermined origin were reviewed for previous medical history, diagnostic study, histologic diagnosis, and prior Papanicolaou smear abnormalities. RESULTS: The incidence of atypical glandular cells of undetermined origin in 76,018 Papanicolaou smears was 0.196%. We reviewed 133 patient medical records with cytologic diagnoses. Eighty of these patients have had appropriate follow-up. Thirty-six (45%) of these were found to have significant histologic abnormalities, including 6 patients with cervical intraepithelial neoplasia, grades 2 and 3, and 4 invasive cancers. CONCLUSION: The frequency of underlying serious histologic changes is much greater in atypical glandular cells than in atypical squamous cells of undetermined significance. On the basis of our results, we believe that all patients with atypical glandular cells should undergo intensive evaluation including colposcopy, cervical biopsy, and endocervical curettage. When diagnosis cannot be clearly established, patient should undergo endometrial biopsy.     

Managing atypical squamous cells of undetermined significance in Papanicolaou smears

OBJECTIVE: To assess strategies using repeated conventional Pap smear and human papillomavirus (HPV) DNA testing, alone or in combination, for identifying women with concomitant cervical intraepithelial neoplasia 2 and 3 (CIN 2/3) in women with atypical squamous cells of undetermined significance (ASCUS) in their Pap smears. STUDY DESIGN: A total of 360 women cytologically diagnosed with ASCUS were referred for colposcopy and underwent a repeat Pap smear, a biopsy when necessary and HPV testing using three different modes of detection of high-oncogenic-risk HPV types: 1, first-generation Hybrid Capture test (HC-1) (Digene Diagnostics, Gaithersburg, Maryland); 2, second-generation Hybrid Capture test (HC-2); and 3, polymerase chain reaction (PCR). RESULTS: Nineteen patients (5.3%) had histologic CIN 2/3. The sensitivity and specificity of the repeat Pap smear alone for the detection of CIN 2/3 were 73.7% and 62.9%, respectively, when referring all women with a repeat Pap smear using an ASCUS-positive threshold. The proportion of women referred for colposcopy was 39.0%. When HPV testing for high risk was used for identification of women with histologic CIN 2/3, sensitivity and specificity were, respectively, 68.4% and 85.9% for HC-1, 89.5% and 73.9% for HC-2 and 89.5% and 59.0% for PCR. The rate of referral for colposcopy of these three modes of HPV testing was 16.9%, 29.4% and 44.0%, respectively. The sensitivity and specificity for identification of women with concomitant CIN 2/3 using a combination of repeat cytology showing a low grade squamous intraepithelial lesion or high grade squamous intraepithelial lesion and/or a test positive for high-oncogenic-risk HPV group were, respectively, 94.7% and 73.2% when used in combination with HC-2. The referral rate of women for colposcopy of this combined strategy was 30.4%. CONCLUSION: As compared to the strategy using abnormal repeat Pap smear alone, those using high-risk HPV testing with Hybrid Capture showed statistically significantly higher specificities and lower proportions of women with ASCUS referred for colposcopy. In particular, a promising strategy would be to refer for colposcopy only women with repeat Pap smears showing squamous intraepithelial lesion and/or those positive for high-risk HPV detected by Hybrid Capture testing.     

Cervical neoplasia after diagnosis and follow-up of women with atypical squamous cells of undetermined significance

BACKGROUND: Although the cytological finding of atypical squamous cells of undetermined significance (ASCUS) occurs in around 5% of women undergoing cytological screening, the clinical evolution is unknown. The objective of this study was to evaluate women with a diagnosis of ASCUS and compare the histological findings and clinical evolution over six and 12 months. METHODS: 1244 patients with ASCUS (two diagnostic cytologists) were evaluated in this study with Pap Smears and colposcopy (biopsy if necessary) at the first visit, and thereafter at second and third visits (6 and 12 months after the first visit). Comparisons were made between cytological findings and histological diagnoses at every visit during the study and during evolution. RESULTS: At the first visit, 60.3% of the biopsied patients presented histological findings of CIN I, 17.46% CIN II/III and 6.3% invasive neoplasia. At the second visit, 48.3% of the biopsied patients presented CIN I, 24.1% CIN II/III and none invasive neoplasia. At the third visit, 68.9% of the biopsied patients presented CIN I, 13.8% CIN II/III and none invasive carcinoma. If we consider all visits, a total of 213 colposcopy-guided biopsies were performed, representing 17.1% of all the patients included. Of these, 164 (13.2%) presented a histological diagnosis of cervical intraepithelial neoplasia (CIN) and eight (0.6%) presented with invasive carcinoma. CONCLUSION: We conclude that CIN or invasive lesions frequently occur in women with a diagnosis of ASCUS. Immediate review of the thin sections, new cytological tests or colposcopy and rigorous follow-up should be considered when making a diagnosis of ASCUS.     

Colposcopic evaluation after a repeat atypical squamous cells of undetermined significance (ASCUS) smear.

OBJECTIVES: Management of patients with atypical squamous cells of undetermined significance (ASCUS) remains controversial. We chose to repeat the Pap smear after four months. If ASCUS persisted in this second test, the patient was advised to undergo colposcopy. Our objective is to determine the clinical significance and the prediction of neoplasia among these patients through a colposcopic examination. METHODS: Of 29,827 patients who had a Pap smear, ASCUS were detected in 1387 (5%) and persisted in the repeat smear of 225 (16%). Colposcopy and an additional Pap smear were performed on 186 patients. RESULTS: Out of 186 colposcopic evaluations, 91 (49%) were normal and the patients had a negative Pap smear. Colposcopy was abnormal in 95/186 patients (51%) (Table 1). Histology of the directed biopsies revealed 38 (21%) low-grade squamous intraepithelial lesions (LSIL) and 17 (9%) high-grade squamous intraepithelial lesions (HSIL). Forty patients (21%) with normal biopsies had ASCUS for the third time in the Pap smear. CONCLUSIONS: Colposcopic evaluation after a repeated Pap smear with ASCUS is an appropriate cost-effective management. Finding 30% of LSIL or HSIL justifies this additional investigation.     

Significance of atypical squamous cells of undetermined significance on ThinPrep papanicolaou smears

OBJECTIVE: The aim of this study was to assess the prevalence and risk factors predictive of dysplasia among women seen in a gynecologic oncology service with the cytologic diagnosis of atypical squamous cells of undetermined significance (ASCUS) on Papanicolaou smears obtained by the ThinPrep method. METHODS: Patients with ASCUS ThinPrep Papanicolaou smears seen at the Division of Gynecologic Oncology, University of Vermont, between 1997 and 1999 were identified. The cytologic smears were reviewed and subtyped into reactive or suggestive of squamous intraepithelial lesion (SIL). The charts of these patients were reviewed and the following information was abstracted: age, gravidity, parity, menopausal status, use of hormonal replacement therapy, smoking, history of pelvic cancer, history of radiation therapy, history of abnormal Papanicolaou smear and its treatment, history of human papillomavirus (HPV) infection, and follow-up information including results of repeat Papanicolaou smears, colposcopy, and biopsies. The prevalence of dysplasia was calculated. The demographic features of women with ASCUS, reactive, were compared with those with ASCUS, SIL, using a two-sample t test, chi(2), and Fisher's exact test. Risk factors predictive of dysplasia were calculated using the odds ratio and the 95% confidence interval. P < 0.05 was considered significant. RESULTS: One hundred twenty-six patients with ASCUS on ThinPrep Papanicolaou smear were identified; 63 patients had ASCUS, reactive, and 63 patients had ASCUS, SIL. The demographic features of both groups were similar. The overall prevalence of dysplasia was 15.9% and was significantly higher among women with ASCUS, SIL, than among women with ASCUS, reactive (25.4% versus 6.4%, P = 0.003). The type of ASCUS cytology (reactive versus SIL), smoking, and history of HPV were significant risk factors for dysplasia (P = 0.003, 0.037, and 0. 042, respectively). CONCLUSIONS: The prevalence of dysplasia among women seen in a gynecologic oncology service with ASCUS cytology on ThinPrep Papanicolaou smears is 15.9%. Women with ASCUS favor SIL, those who smoke, and those with a history of HPV are at higher risk for dysplasia and should be offered colposcopy.     

Predictors of atypical squamous cell of undetermined significance cervical cytology with high-risk human papilloma virus genotypes

Objective  

To investigate epidemiological factors that predicts high-risk human papillomavirus (HR-HPV) types among women with atypical squamous cells of undetermined significance (ASCUS).     

Management of women with atypical Papanicolaou tests of undetermined significance by board-certified gynecologists: discrepancies with published guidelines

OBJECTIVE: The Bethesda System introduced 2 categories of atypia: atypical glandular cells of undetermined significance (AGUS) and atypical squamous cells of undetermined significance (ASCUS). Our objective was to test the hypothesis that there is lack of consensus regarding management of women with ASCUS and AGUS. STUDY DESIGN: A 2-page survey was mailed in April 1998 to a random sample of 491 fellows of the American College of Obstetricians and Gynecologists. RESULTS: There were 241 responses (50.6%). For first-time ASCUS, 23.0% of respondents would perform colposcopy and 24.4% would repeat the Papanicolaou test in <3 months, indicating aggressive management of ASCUS by 47.4% of respondents. For recurrent ASCUS, 88.7% followed recommendations to manage with colposcopy. For AGUS, 23% repeated the Papanicolaou test and only 43% would manage appropriately. For recurrent AGUS, only 25% would perform surgical excision. CONCLUSION: Compared with published guidelines, practitioners undermanage patients with AGUS and overmanage patients with ASCUS. Further physician education appears to be warranted.