Management guidelines for women with Papanicolaou (Pap) test interpretations of ASC-H (atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion) reflect substantial risk, which ranges from 10% to 68%, of a cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in their follow-up histologic samples. The present study was initiated to determine the number of colposcopic procedures and the time frame that are typically required for a definitive diagnosis of a CIN2+ lesion after a Papanicolaou (Pap) test interpretation of ASC-H in routine practice.
Clinicopathologic data on consecutive ASC-H interpretations, 97% of which were on liquid-based preparations, were reviewed. The number of biopsies (which was used in this context as a surrogate indicator for the number of colposcopic procedures) as well as the average duration required for a follow-up histologic diagnosis of CIN2+ were determined.
Of 500 ASC-H interpretations, 75 were excluded for a variety of reasons and 165 lacked follow-up in our records. The average age and follow-up duration for the remaining 260 patients was 35.6 years and 18.5 months, respectively. CIN2+ was diagnosed in 49 (40%) of the 122 patients with at least 1 histologic follow-up. Of these 49 patients, 72% (35 of 49) were diagnosed on the first follow-up cervical biopsy, 14% (7 of 49) and 8% (4 of 49) were diagnosed on the second and third follow-up biopsies, respectively; in only 6% (3 of 49) was a fourth follow-up biopsy required. Overall, an average of 1.53 biopsies (range, 1-4) was required to attain a definitive diagnosis of CIN2+, and 28% of patients required more than 1 follow-up biopsy. The average period between the index ASC-H interpretations and CIN2+ diagnoses was 5.5 months. The average time to CIN2+ diagnoses by the first follow-up biopsy was 3 months; for diagnoses made on subsequent biopsies, the average additional follow-up duration was 8 months. Of the eventual CIN2+ diagnoses, 84% were rendered within 12 months of their associated index ASC-H interpretations.
1) A substantial subset-28%-of patients with biopsy-proven CIN2+ after ASC-H interpretations required more than 1 colposcopy for a definitive diagnosis of a high-grade dysplastic lesion. 2) If a CIN2+ lesion is present, the vast majority can be diagnosed in a biopsy performed within 1 year of the ASC-H interpretation.