Pathology Outlines - ASCUS (cytology) 10 - 20% of women with ASCUS are proven to have underlying high grade squamous intraepithelial lesion (HSIL) (Am J Obstet Gynecol 2003;188:1383) 5 year risks for HSIL and cancer: ASCUS with negative HPV, 1 1%; ASCUS with positive HPV, 18% (N Engl J Med 2013;369:2324)
Pathology Outlines - LSIL (cytology) Atypical squamous cells of undetermined clinical significance (ASCUS): Nuclei approximately 2 5 - 3x the area of the nucleus of a normal intermediate squamous cell or 2x the size of a squamous metaplastic cell nucleus Slightly increased N C ratio Minimal nuclear hyperchromasia and irregular chromatin distribution or nuclear shape
Pathology Outlines - ASC-H (cytology) Initially endorsed in 2001 as triage test for ASCUS (ASC of undetermined significance) cytologic result Approved for: Cotesting in 2003 Postcolposcopic posttreatment follow up and risk stratification using partial genotype (HPV 16 18) in 2006 Primary screening option in 2014 5 FDA approved HPV testing platforms: Qiagen Hybrid Capture
Pathology Outlines - Bethesda system ASCUS nuclei are enlarged by 2 to 3 times, have smooth to slightly irregular nuclear membranes, finely granular chromatin, inconspicuous nucleoli and questionable cytoplasmic cavitations LSIL nuclei are enlarged by 3 to 4 times, have smooth to slightly irregular nuclear membranes, slightly more granular chromatin, absent nucleoli and
Pathology Outlines - Squamous dysplasia Can be categorized as LSIL, HSIL or atypical squamous cells of uncertain significance (ASCUS) LSIL: hyperchromasia, nuclear irregularity, koilocytotic atypia and > 3 fold nuclear enlargement compared to superficial squamous cells
Pathology Outlines - HSIL CIN II CIN III A 32 year old woman presented after 2 consecutive Pap tests revealing atypical squamous cells of undetermined significance (ASCUS) Colposcopic exam was unsatisfactory Loop electrosurgical excision procedure (LEEP) was performed and showed the histologic findings in the image above
Pathology Outlines - HSIL (cytology) Initially endorsed as triage test for ASCUS cytologic result in 2001 Approved for: Cotesting in 2003 Postcolposcopic posttreatment follow up and risk stratification using partial genotype (HPV 16 18) in 2006 Primary screening option in 2014 5 FDA approved HPV testing platforms: Qiagen Hybrid Capture Hologic Cervista Hologic Aptima
Pathology Outlines - HPV overview Reflex testing for ASCUS and in postmenopausal women, for low grade SIL Genotyping for HPV 16, 18 or 45 Follow up for abnormal cervical cytology and HPV screening with negative colposcopy Follow up after treatment for cervical precancer Cervical cancer screening guideline (J Low Genit Tract Dis 2020;24:102):