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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
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.
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.
- 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.