Importance of atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H)

Yıl 2019, Cilt: 36 Sayı: 4, 113 - 119, 02.03.2020

Murat Alan , Muhammet Ali Oruç Yasemin Alan , Hakkı Aytaç Duygu Ayaz , Volkan Karataşlı Muzaffer Sancı

Öz

In this study, we evaluated the biopsy counterparts of atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H) cases. This was a cross-sectional, retrospective study on ASC-H cases. The follow-up results of ASC-H cases diagnosed during routine primary screening between 2011 and 2018 were evaluated, and the relationship between clinicopathological parameters, high risk Human Papilloma Virus (hrHPV) test and patients’ ages at diagnosis were evaluated. Among one hundred sixty-nine ASC-H patients, high grade squamous intraepithelial lesion (HSIL) was detected in 56 (33.1%), low grade squamous intraepithelial lesion (LSIL) in 59 (35%), squamous cell carcinoma in 5 (3%) and adenocarcinoma in 1 (0.5%). HPV 16 was detected in 41 (24.4%) cases and HPV 18 in 26 (16%) cases, and 51 patients had low risk of HPV (lrHPV). The mean age of the patients with hrHPV was 31.78 ± 8.22, and the mean age of the patients with lrHPV was 34.77 ± 5.47. HPV positivity in ASC-H smears was significantly correlated with age (p = 0.004). General linear regression analysis showed that biopsy results were significantly correlated with HPV in high-risk patients compared to low-risk patients. hrHPV evaluation in ASC-H follow-up is significant for cervical premalignant lesion. A management strategy that requires close monitoring in women with ASCH and under 40 years old, especially in association with hrHPV, should be considered.

Anahtar Kelimeler

ASC-H, Cervical Premalign Lesion, Histopathology, HPV

Kaynakça

• Reference1.Wilson CM, Tobin S, Young RC. The exploding worldwide cancer burden: the impact of cancer on women. Int J Gynecol Cancer 2004;14(1):1-11.Reference2. Waxman AG. Guidelines for cervical cancer screening, history and scientific rationale. Clin Obstet Gynecol 2005;48(1):77-97.Reference3. Papanicolaou GN, Traut HF. The diagnostic value of vaginal smears in carcinoma of the uterus. 1941. Arch Pathol Lab Med 1997;121(3):211-24.Reference4. Koss LG. The Papanicolaou test for cervical cancer detection. A triumph and a tragedy. JAMA 1989;261(5):737-43.Reference5. Apgar BS, Zoschnick L, Wright TC Jr. The 2001 Bethesda System terminology. Am Fam Physician 2003;68(10):1992-8.Reference6. Galliano GE, Moatamed NA, Lee S, Salami N, Apple SK. Reflex high risk HPV testing in atypical squamous cells, cannot exclude high grade intraepithelial lesion: a large institution’s experience with the significance of this often ordered test. Acta Cytol 2011;55:167–172Reference7. Gilani SM, Tashjian R, Fathallah L. Cervical cytology with a diagnosis of atypical cells, cannot exclude highgrade squamous intraepithelial lesion (ASC-H): a followup study with corresponding histology and significance of predicting dysplasia by human papillomavirus (HPV) DNA testing. Arch Gynecol Obstet 2014; 289: 645-8.Reference8. Solomon D, Schiffman M, Tarone R. Comparison of three management strategies for patients with atypical squamous cells of undetermined significance: Baseline results from a randomized trial. J Natl Cancer Inst 2001;93:293–299Reference9. Nieh S, Chen SF, Chu TY, Lai HC, Lin YS, Fu E et al. Is p16 (INK4A) expression more useful than human papillomavirus test to determine the outcome of atypical squamous cells of undetermined significance-categorized Pap smear? A comparative analysis using abnormal cervical smears with follow-up biopsies. Gynecol Oncol 2005; 97:35–40.Reference10. Gultekin M, Zayifoglu Karaca M, et al.: Initial results of population based cervical cancer screening program using HPV testing in one million Turkish women. Int J Cancer.2018;142(9): 1952-1958.Reference11.Milutin Gasperov N, Sabol I, Matovina M, Spaventi S, Grce M. Detection and typing of human papilloma viruses combining different methods: polymerase chain reaction, restriction fragment length polymorphism, line probe assay and sequencing. Pathol Oncol Res 2008;14(4):355-63.Reference12. Louro AP, Roberson J, Eltoum I, Chhieng DC. 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. 2003;120(3):392-7.Reference13.Saad R, Dabbs D, Korkunsky L, et al. Clinical significance of cytologic diagnosis of atypical squamous cells, cannot exclude a high grade squamous intraepithelial lesion in perimenopausal and postmenopausal women. Am J Clin Pathol. 2006;126:381–388.Reference14. Selvaggi SM. Reporting of atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion (ASC-H) on cervical samples: is it significant? Diagn Cytopathol. 2003;29(1):38-41.Reference15. Xu L, Verdoodt F, Wentzensen N, Bergeron C, Arbyn M. Triage of ASC-H: a meta-analysis of the accuracy of hrHPV testing and other markers to detect cervical precancer. Cancer Cytopathol 2016; 124(4):261-272.Reference16.Gilani SM, Tashjian R, Fathallah L. Cervical cytology with a diagnosis of atypical cells, cannot exclude highgrade squamous intraepithelial lesion (ASC-H): a followup study with corresponding histology and significance of predicting dysplasia by human papillomavirus (HPV) DNA testing. Arch Gynecol Obstet 2014; 289: 645-8.Reference17.Patton AL, Duncan L, Bloom L, Phaneuf G, Zafar N. Atypical squamous cells, cannot exclude a high-grade intraepithelial lesion and its clinical significance in postmenopausal, pregnant, postpartum, and contraceptive-use patients. Cancer 2008; 114:481–488.Reference18.Solomon D, Schiffman M, Tarone R. Comparison of three management strategies for patients with atypical squamous cells of undetermined significance: Baseline results from a randomized trial. J Natl Cancer Inst 2001;93:293–299 (ALTS)Reference19.Sherman ME, Solomon D, Schiffman M. A comparison of equivocal LSIL and equivocal HSIL cervical cytology in the ASCUS LSIL Triage Study. Am J Clin Pathol. 2001;116:385–394.Reference20. Sung CO, Kim SR, Oh YL, Song SY. The use of p16INK4a immunocytochemistry in atypical squamous cells which cannot exclude HSIL[ compared with Batypical squamous cells of undetermined significance[ in liquid-based cervical smears. Diagn Cytopathol 2009. E-pub ahead of print.Reference21. Mokhtar GA, Delatour NL, Assiri AH, Gilliatt MA, Senterman M, Islam S. Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion: Cytohistologic correlation study with diagnostic pitfalls. Acta Cytol 2008;52:169Y77.Reference22.Cytryn A, Russomano FB, Camargo MJ, et al. 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 2009;127:283–7.Reference23.Kietpeerakool C, Srisomboon J, Tantipalakorn C, et al. Underlying pathology of women with ‘‘atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion’’ smears, in a region with a high incidence of cervical cancer. J Obstet Gynaecol Res 2008;34:204–9.Reference24.Chang Ohk Sung, Young Lyun Oh, Sang Yong Song. Cervical cytology of atypical squamous cells cannot exclude high-grade squamous intra-epithelial lesion: significance of age, human papillomavirus DNA detection and previous abnormal cytology on follow-up outcomes European Journal of Obstetrics & Gynecology and Reproductive Biology 159 (2011) 155–159Reference25. Wright TC, Massad S, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D, for the 2006 American Society for Colposcopy and Cervical Pathology-sponsored Consensus Conference. Consensus guidelines for the management of women with abnormal cervical screening tests. J Low Genit Tract Dis 2007;11:201Y22.