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Related Experiment Videos

Smears diagnosed as ASCUS: interobserver variation and follow-up.

R M Gatscha1, M Abadi, S Babore

  • 1Department of Cytology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. gatschar@mskcc.org

Diagnostic Cytopathology
|July 31, 2001
PubMed
Summary

Rescreening cervical cytology diagnosed as atypical squamous cells of undetermined significance (ASCUS) revealed significant discrepancies. Careful patient follow-up is crucial for ASCUS diagnoses to detect squamous intraepithelial lesions (SIL) or carcinoma.

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Area of Science:

  • Cytopathology
  • Cervical Cancer Screening
  • Diagnostic Accuracy

Background:

  • Atypical squamous cells of undetermined significance (ASCUS) is a common cytologic diagnosis.
  • The Bethesda System for Reporting Cervical/Vaginal Cytologic Diagnoses (TBS) provides criteria for ASCUS diagnosis.
  • Accurate ASCUS classification is essential for appropriate patient management and follow-up.

Purpose of the Study:

  • To evaluate the reliability of ASCUS diagnoses by applying TBS criteria during rescreening.
  • To compare initial ASCUS diagnoses with rescreening results.
  • To analyze the correlation between rescreening diagnoses and subsequent follow-up findings (cytology or histology).

Main Methods:

  • Rescreening of 632 cervicovaginal specimens previously diagnosed as ASCUS by two cytotechnologists and one cytopathology fellow.

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  • Application of established ASCUS criteria from the Bethesda System.
  • Categorization of rescreen diagnoses into within normal limits (WNL), ASCUS, low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), or carcinoma (CA).
  • Analysis of agreement between initial and rescreen diagnoses, and correlation with follow-up data.

    • Main Results:

    • Complete agreement between initial and rescreen diagnoses was observed in only 32% of cases.
    • Partial agreement was found in 62% of cases, with complete disagreement in 6%.
    • Follow-up revealed squamous intraepithelial lesions (SIL) or worse in 29% of cases initially classified as WNL on rescreen, 29% of those rediagnosed as ASCUS, and 34% of those reclassified as SIL.
    • Overall, 30% of cases initially diagnosed as ASCUS showed SIL or carcinoma upon follow-up.

    Conclusions:

    • Rescreening of ASCUS diagnoses reveals substantial inter-observer variability.
    • A significant proportion of cases initially diagnosed as ASCUS harbor underlying SIL or carcinoma, underscoring the importance of diligent follow-up.
    • The diagnosis of ASCUS necessitates careful patient management and monitoring to ensure timely detection of significant cervical pathology.