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Skin cancer is a type of cancer that occurs when there is an abnormal growth of skin cells, usually triggered by damage to the DNA within the skin cells. It is primarily caused by exposure to ultraviolet (UV) radiation from the sun or artificial sources like tanning beds. Skin cancer is the most common type of cancer worldwide, and its incidence continues to rise.
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The gray zone squamous lesions: ASC-US / ASC-H.

Jayasree Kattoor1, Meherbano M Kamal2

  • 1Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India.

Cytojournal
|June 8, 2022
PubMed
Summary

Atypical Squamous cells (ASC) are a borderline category in cervical cytology. Despite challenges in interpretation, retaining ASC of undetermined significance (ASC-US) and ASC-cannot rule out high-grade lesion (ASC-H) is crucial for accurate diagnosis and patient management.

Keywords:
Atypical squamous cellsAtypical squamous cells-HAtypical squamous cells-USChallenges in cytomorphologic interpretations of atypical squamous cellsDifferential diagnosis of atypical squamous cells-HDifferential diagnosis of atypical squamous cells-US

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Area of Science:

  • Cervical Cytology
  • Pathology
  • Gynecologic Oncology

Background:

  • Low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL) are distinct cervical cytology findings.
  • Borderline categories like Atypical Squamous cells (ASC) arise when diagnostic features are insufficient, often due to suboptimal sample preparation.
  • The Bethesda System 2014 classifies ASC into ASC of undetermined significance (ASC-US) and ASC-cannot rule out high-grade lesion (ASC-H).

Purpose of the Study:

  • To detail the morphologic features of the ASC category in cervical cytology.
  • To discuss diagnostic challenges and differential diagnoses for ASC.
  • To underscore the clinical significance of ASC classification in patient management.

Main Methods:

  • Review of morphologic criteria for ASC classification.
  • Analysis of factors contributing to diagnostic uncertainty in cervical smears.
  • Examination of the impact of ASC subcategories on clinical follow-up protocols.

Main Results:

  • Suboptimal sample quality frequently leads to the ASC category.
  • ASC-US and ASC-H classifications have distinct implications for patient management, including repeat Pap smears, HPV testing, or colposcopy.
  • Eliminating ASC categories could lead to increased LSIL rates or missed high-grade lesions.

Conclusions:

  • The ASC category, despite reproducibility concerns, remains essential in cervical cytology.
  • Accurate interpretation of ASC subcategories is vital for appropriate clinical decision-making and patient surveillance.
  • Understanding ASC morphologic features aids in differentiating benign conditions from significant lesions.