Prevalence of cervical intraepithelial neoplasia grades II/III and cervical cancer in patients with cytological diagnosis of atypical squamous cells when high-grade intraepithelial lesions (ASC-H) cannot be ruled out

• Published in: São Paulo medical journal Vol. 127; no. 5; pp. 283 - 287
• Main Authors: Cytryn, Andréa, Russomano, Fábio Bastos, Camargo, Maria José de, Zardo, Lucília Maria Gama, Horta, Nilza Maria Sobral Rebelo, Fonseca, Rachel de Carvalho Silveira de Paula, Tristão, Maria Aparecida, Monteiro, Aparecida Cristina Sampaio
• Format: Journal Article
• Language: English
• Published: Brazil Associação Paulista de Medicina - APM 01-09-2009; Associação Paulista de Medicina
• Subjects: Adolescent; Adult; Aged; Brazil - epidemiology; Cervical intraepithelial neoplasia; Cervical Intraepithelial Neoplasia - epidemiology; Cervical Intraepithelial Neoplasia - pathology; Cervix uteri; Colposcopy; Cross-Sectional Studies; Cytology; Female; Humans; MEDICINE, GENERAL & INTERNAL; Middle Aged; Neoplasm Staging; Neoplasms, Squamous Cell - epidemiology; Neoplasms, Squamous Cell - pathology; Original; Prevalence; Retrospective Studies; Uterine cervical neoplasm; Uterine Cervical Neoplasms - epidemiology; Uterine Cervical Neoplasms - pathology; Young Adult; Brazil; Neoplasias do colo do útero; Colposcopy; Cervix uteri; Colo do útero; Colposcopia; Uterine cervical neoplasm; Cervical intraepithelial neoplasia; Cytology; Citologia; Neoplasia intra-epitelial cervical
• ISSN: 1516-3180; 1806-9460; 1806-9460; 1516-3180
• DOI: 10.1590/S1516-31802009000500007

The latest update of the Bethesda System divided the category of atypical squamous cells of undetermined significance (ASCUS) into ASC-US (undetermined significance) and ASC-H (high-grade intraepithelial lesion cannot be ruled out). The aims here were to measure the prevalence of pre-invasive lesions (cervical intraepithelial neoplasia, CIN II/III) and cervical cancer among patients referred to Instituto Fernandes Figueira (IFF) with ASC-H cytology, and compare them with ASC-US cases.
Cross-sectional study with retrospective data collection, at the IFF Cervical Pathology outpatient clinic.
ASCUS cases referred to IFF from November 1997 to September 2007 were reviewed according to the 2001 Bethesda System to reach cytological consensus. The resulting ASC-H and ASC-US cases, along with new cases, were analyzed relative to the outcome of interest. The histological diagnosis (or cytocolposcopic follow-up in cases without such diagnosis) was taken as the gold standard.
The prevalence of CIN II/III in cases with ASC-H cytology was 19.29% (95% confidence interval, CI, 9.05-29.55%) and the risk of these lesions was greater among patients with ASC-H than with ASC-US cytology (prevalence ratio, PR, 10.42; 95% CI, 2.39-45.47; P = 0.0000764). Pre-invasive lesions were more frequently found in patients under 50 years of age with ASC-H cytology (PR, 2.67; 95% CI, 0.38-18.83); P = 0.2786998). There were no uterine cervical cancer cases.
The prevalence of CIN II/III in patients with ASC-H cytology was significantly higher than with ASC-US, and division into ASC diagnostic subcategories had good capacity for discriminating the presence of pre-invasive lesions.