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Should LSIL with ASC-H (LSIL-H) in cervical smears be an independent category? A study on SurePath specimens with review of literature.

Shidham VB, Kumar N, Narayan R, Brotzman GL - Cytojournal (2007)

Bottom Line: The status of HPV DNA testing was also noted in some LSIL-H cases with biopsy results.Biopsy results were grouped into A. negative for dysplasia (ND), B. low grade (HPV, CIN1, CIN1 with HPV), and C. high grade (CIN 2 and above).The positive predictive values for various biopsy results in relation to initial cytopathologic interpretation were: a.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. vshidham@mcw.edu

ABSTRACT

Background: Cervical smears exhibiting unequivocal features of 'low grade squamous intraepithelial lesion' (LSIL) are occasionally also admixed with some cells suspicious for, but not diagnostic of, 'high grade squamous intraepithelial lesion' (HSIL). Only a few studies, mostly reported as abstracts, have evaluated this concurrence. In this study, we evaluate the current evidence that favors a distinct category for "LSIL, cannot exclude HSIL" (LSIL-H), and suggest a management algorithm based on combinations of current ASCCP guidelines for related interpretations.

Methods: We studied SurePath preparations of cervical specimens from various institutions during one year period. Cytohisto correlation was performed in cases with cervical biopsies submitted to our institution. The status of HPV DNA testing was also noted in some LSIL-H cases with biopsy results.

Results: Out of 77,979 cases 1,970 interpreted as LSIL (1,523), LSIL-H (146), 'atypical squamous cells, cannot exclude HSIL' (ASC-H) (109), and HSIL (192) were selected. Concurrent biopsy results were available in 40% (Total 792 cases: 557 LSIL, 88 LSIL-H, 38 ASCH, and 109 HSIL). Biopsy results were grouped into A. negative for dysplasia (ND), B. low grade (HPV, CIN1, CIN1 with HPV), and C. high grade (CIN 2 and above). The positive predictive values for various biopsy results in relation to initial cytopathologic interpretation were: a. LSIL: (557 cases): ND 32% (179), low grade 58% (323), high grade 10% (55); b. LSIL-H: (88 cases): ND 24% (21), low grade 43% (38), high grade 33% (29); c. ASCH: (38 cases): ND 32% (12), low grade- 37% (14), high grade- 31% (12); d. HSIL (109 cases): ND 5% (6), low grade 26% (28), high grade 69% (75). The patterns of cervical biopsy results in cases reported as LSIL-H were compared with that observed in cases with LSIL, ASC-H, and HSIL. 94% (32 of 34) of LSIL-H were positive for high risk (HR) HPV, 1 was negative for HR HPV but positive for low risk (LR), and 1 LSIL-H was negative for HR and LR both.

Conclusion: LSIL-H overlapped with LSIL and ASC-H, but was distinct from HSIL. A management algorithm comparable to ASC-H and HSIL appears to be appropriate in LSIL-H cases.

No MeSH data available.


Related in: MedlinePlus

LSIL-H (with only HPV in biopsy): Cervical smear (a, b) showed unequivocal LSIL cells in other fields. This field shows rare LSIL (a & b) along with some groups of cells consistent with ASC-H. The biopsy (c) showed only human papilloma virus cytopathic effect. Small atypical parakeratotic (SAPK) cells with distinct and sharp angulated cell borders with tinge of cytoplasmic eosinophilia (arrowhead in b) (see also corresponding area in a) were interpreted as ASC-H component. (a & b- Papanicolaou stained SurePathTM preps, c- HE stained cervical biopsy section).
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Figure 3: LSIL-H (with only HPV in biopsy): Cervical smear (a, b) showed unequivocal LSIL cells in other fields. This field shows rare LSIL (a & b) along with some groups of cells consistent with ASC-H. The biopsy (c) showed only human papilloma virus cytopathic effect. Small atypical parakeratotic (SAPK) cells with distinct and sharp angulated cell borders with tinge of cytoplasmic eosinophilia (arrowhead in b) (see also corresponding area in a) were interpreted as ASC-H component. (a & b- Papanicolaou stained SurePathTM preps, c- HE stained cervical biopsy section).

Mentions: In the current study, we evaluated cervical biopsies in cases of "LSIL with ASC-H" (LSIL-H) (Figure 2 &3) in comparison to other categories in Bethesda 2001, to see if this designation as a distinct category is justified.


Should LSIL with ASC-H (LSIL-H) in cervical smears be an independent category? A study on SurePath specimens with review of literature.

Shidham VB, Kumar N, Narayan R, Brotzman GL - Cytojournal (2007)

LSIL-H (with only HPV in biopsy): Cervical smear (a, b) showed unequivocal LSIL cells in other fields. This field shows rare LSIL (a & b) along with some groups of cells consistent with ASC-H. The biopsy (c) showed only human papilloma virus cytopathic effect. Small atypical parakeratotic (SAPK) cells with distinct and sharp angulated cell borders with tinge of cytoplasmic eosinophilia (arrowhead in b) (see also corresponding area in a) were interpreted as ASC-H component. (a & b- Papanicolaou stained SurePathTM preps, c- HE stained cervical biopsy section).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1851019&req=5

Figure 3: LSIL-H (with only HPV in biopsy): Cervical smear (a, b) showed unequivocal LSIL cells in other fields. This field shows rare LSIL (a & b) along with some groups of cells consistent with ASC-H. The biopsy (c) showed only human papilloma virus cytopathic effect. Small atypical parakeratotic (SAPK) cells with distinct and sharp angulated cell borders with tinge of cytoplasmic eosinophilia (arrowhead in b) (see also corresponding area in a) were interpreted as ASC-H component. (a & b- Papanicolaou stained SurePathTM preps, c- HE stained cervical biopsy section).
Mentions: In the current study, we evaluated cervical biopsies in cases of "LSIL with ASC-H" (LSIL-H) (Figure 2 &3) in comparison to other categories in Bethesda 2001, to see if this designation as a distinct category is justified.

Bottom Line: The status of HPV DNA testing was also noted in some LSIL-H cases with biopsy results.Biopsy results were grouped into A. negative for dysplasia (ND), B. low grade (HPV, CIN1, CIN1 with HPV), and C. high grade (CIN 2 and above).The positive predictive values for various biopsy results in relation to initial cytopathologic interpretation were: a.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. vshidham@mcw.edu

ABSTRACT

Background: Cervical smears exhibiting unequivocal features of 'low grade squamous intraepithelial lesion' (LSIL) are occasionally also admixed with some cells suspicious for, but not diagnostic of, 'high grade squamous intraepithelial lesion' (HSIL). Only a few studies, mostly reported as abstracts, have evaluated this concurrence. In this study, we evaluate the current evidence that favors a distinct category for "LSIL, cannot exclude HSIL" (LSIL-H), and suggest a management algorithm based on combinations of current ASCCP guidelines for related interpretations.

Methods: We studied SurePath preparations of cervical specimens from various institutions during one year period. Cytohisto correlation was performed in cases with cervical biopsies submitted to our institution. The status of HPV DNA testing was also noted in some LSIL-H cases with biopsy results.

Results: Out of 77,979 cases 1,970 interpreted as LSIL (1,523), LSIL-H (146), 'atypical squamous cells, cannot exclude HSIL' (ASC-H) (109), and HSIL (192) were selected. Concurrent biopsy results were available in 40% (Total 792 cases: 557 LSIL, 88 LSIL-H, 38 ASCH, and 109 HSIL). Biopsy results were grouped into A. negative for dysplasia (ND), B. low grade (HPV, CIN1, CIN1 with HPV), and C. high grade (CIN 2 and above). The positive predictive values for various biopsy results in relation to initial cytopathologic interpretation were: a. LSIL: (557 cases): ND 32% (179), low grade 58% (323), high grade 10% (55); b. LSIL-H: (88 cases): ND 24% (21), low grade 43% (38), high grade 33% (29); c. ASCH: (38 cases): ND 32% (12), low grade- 37% (14), high grade- 31% (12); d. HSIL (109 cases): ND 5% (6), low grade 26% (28), high grade 69% (75). The patterns of cervical biopsy results in cases reported as LSIL-H were compared with that observed in cases with LSIL, ASC-H, and HSIL. 94% (32 of 34) of LSIL-H were positive for high risk (HR) HPV, 1 was negative for HR HPV but positive for low risk (LR), and 1 LSIL-H was negative for HR and LR both.

Conclusion: LSIL-H overlapped with LSIL and ASC-H, but was distinct from HSIL. A management algorithm comparable to ASC-H and HSIL appears to be appropriate in LSIL-H cases.

No MeSH data available.


Related in: MedlinePlus