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Reactive cellular change: is there an increased risk for squamous intraepithelial lesions?
1The Department of Pathology, The George Washington University Medical Center, Washington, DC 20037, USA.
Background:
The aim of this study was to evaluate the rate of squamous intraepithelial lesions (SIL) in women with reactive cellular change (RCC) cervical smears and compare the results with a control group with within normal limit (WNL) smears.
Methods:
The study group was comprised of 1000 women with RCC and a control group of 1000 women with WNL cervical smears diagnosed over an 8-month period. Results of the first follow-up (FU) smears were evaluated and compared between the two groups. FU smears with a diagnosis of SIL were reviewed along with the original RCC or WNL smears.
Results:
Six hundred and thirteen women from the RCC group and 640 from the WNL group had FU smears. The mean time to FU was 11.0 and 13.8 months, respectively. FU revealed SIL in 24 of 613 smears in the RCC group (20 low grade [L] SIL and 4 high grade [H] SIL), (3.9%) and in 10 of 640 smears in the WNL group (10 LSIL and 0 HSIL) (1.6%). Fisher's exact test (two-tailed) showed statistical significance (P = 0.014). On retrospective review of the FU smears diagnosed as SIL and their corresponding original RCC or WNL smears, four RCC smears were upgraded to atypical squamous cells of undetermined significance (ASCUS). The remaining diagnoses remained unchanged.
Conclusions:
Women with RCC are more likely to have SIL on a FU smear compared with women with WNL smears (3.9% vs. 1.6%). It is important to emphasize that in the authors' laboratory, the rate of SIL in women with ASCUS is much higher (24%). Awareness of these rates combined with the clinical history may help clinicians determine whether women with RCC require closer FU.