“Atypical squamous cells–cannot exclude high-grade squamous intraepithelial lesion” (ASC-H) cytology is uncommon (0.16%–0.43%). The reported risk of high-grade dysplasia varies hugely (12.00%–70.00%), making management challenging. Primary human papillomavirus (HPV) screening requires an updated understanding of ASC-H.
To review ASC-H colposcopic and histologic comparators, and management outcomes, to help guide future management.
A 1-year retrospective analysis of new ASC-H–associated visits to a large colposcopy unit in Ireland in 2022 was performed.
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). 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.
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.
Author notes
The manuscript was presented as a poster presentation at the BSCCP Annual Scientific Meeting; April 22, 2024; Edinburgh, United Kingdom.
Competing Interests
The authors have no relevant financial interest in the products or companies described in this article.