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Atypical Squamous Cells of Undetermined Significance in Girls and Women

From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri; Department of Obstetrics and Gynecology, Baylor University Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas; Department of Pathology, Huntington Memorial Hospital; Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri; and Department of Pathology, Baylor University Medical Center, Dallas, Texas.

Address reprint requests to: Jason Wright, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, 4911 Barnes Hospital Plaza, Box 8064, St. Louis, MO 63110; e-mail:wrightj{at}msnotes.wustl.edu.

OBJECTIVE: To estimate the outcome of adolescents with atypical squamous cells of undetermined significance (ASC-US) on cytology.

METHODS: A review of ASC-US cytology in girls and women aged 10–19 years between 1995 and 1999 was performed. The cytologic and histologic follow-up of each patient was evaluated. The outcome was recorded as the most significant (highest grade) subsequent cervical smear or biopsy.

RESULTS: Overall, 535 of 7,897 (6.8%) cervical cytologic specimens were reported as ASC-US. The study group consisted of 398 patients for whom pathologic follow-up was available. The mean duration of follow-up was 19 months. Follow-up consisted of repeat cytology in 251 (63%) patients and colposcopy with cervical biopsies and/or endocervical curettage in 147 (37%) of the adolescents. Two hundred fifty-three (64%) adolescents had no pathologic abnormalities on follow-up. Persistent ASC-US was identified in 65 (16%), low-grade squamous intraepithelial lesions/cervical intraepithelial neoplasia (CIN) 1 was found in 44 (11%) and high-grade squamous intraepithelial lesions/CIN 2 or 3 occurred in 36 (9%) of the adolescents. No cases of invasive carcinoma were found.

CONCLUSIONS: Among adolescents with ASC-US, the rate of squamous intraepithelial lesions/CIN is similar to that of adults. Although the optimal management of ASC-US in adolescents is unknown, these patients warrant close follow-up.

LEVEL OF EVIDENCE: III

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				J. D. Wright, J. S. Rader, R. Davila, M. A. Powell, D. G. Mutch, F. Gao, and R. K. Gibb Human papillomavirus triage for young women with atypical squamous cells of undetermined significance. Obstet. Gynecol., April 1, 2006; 107(4): 822 - 829. [Abstract] [Full Text] [PDF]

				J. D. Wright, R. M. Davila, K. R. Pinto, D. F. Merritt, R. K. Gibb, J. S. Rader, D. G. Mutch, F. Gao, and M. A. Powell Cervical Dysplasia in Adolescents Obstet. Gynecol., July 1, 2005; 106(1): 115 - 120. [Abstract] [Full Text] [PDF]