Outcomes and Management of Atypical Squamous Cells-Cannot Exclude High-Grade Squamous Intraepithelial Lesion in a Primary Human Papillomavirus Screening System

Abstract

Context.-“Atypical squamous cells-cannot exclude highgrade squamous intraepithelial lesion” (ASC-H) cytology is uncommon (0.16%-0.43%). The reported risk of high-grade dysplasia varies greatly (12.00%-70.00%), making management challenging. Primary human papillomavirus (HPV) screening requires an updated understanding of ASC-H. Objective.-To review ASC-H colposcopic and histologic comparators, and management outcomes, to help guide future management. Design.-A 1-year retrospective analysis of new ASCH- associated visits to a large colposcopy unit in Ireland in 2022 was performed. Results.-The incidence of new ASC-H referrals was 3.63% (97 of 2672). The sensitivity of colposcopy for detection of high-grade changes (cervical intraepithelial neoplasia [CIN]2+) is 69.39% (34 of 49) and the specificity is 43.18% (19 of 44). The positive predictive value is 64.15% (34 of 53) and the negative predictive value is 37.50% (15 of 40). High-grade dysplasia was identified in 53.26% (49 of 92) and adenocarcinoma in situ in 2.17% (2 of 92) of cases. Excisional treatment was performed for 52.58% (51 of 97) and cold coagulation for 12.37% (12 of 97) of cases. The test-of-cure result was HPV negative for 84.13%. High-risk HPV and abnormal cytology was seen in 9.52% (6 of 63) of cases, thus all required a second test-of-cure smear. Conclusions.-ASC-H with high-risk HPV has a 55.43% (51 of 92) risk of high-grade dysplasia, thus timely colposcopy and biopsy is imperative. Treatment was curative in 84.13% (53 of 63) to 96.83% (61 of 63) of cases, so it is an effective management strategy. Conservative management of selected cases may be a reasonable option.