Clinical implications of the diagnosis “atypical squamous cells, cannot exclude high‐grade squamous intraepithelial lesion” in pregnant women

BACKGROUND Atypical squamous cells, cannot exclude high‐grade squamous intraepithelial lesion (ASC‐H) has a high predictive value for high‐grade intraepithelial lesion (HSIL) in the general population. However, the significance of ASC‐H in pregnant women remains to be elucidated. The objective of this study was to investigate the clinical implications and pathologic significance of ASC‐H in pregnant women, so that these patients will be managed appropriately. METHODS All Papanicolaou tests that were diagnosed as ASC‐H in pregnant women over 1.5 years (total, 60 women) were reviewed and correlated with histologic and/or cytologic follow‐up. High‐risk type of human papillomavirus (HPV) status was also correlated with follow‐up findings. The following cytomorphologic parameters were evaluated for each woman and were compared between the squamous intraepithelial lesion (SIL) follow‐up group and the benign follow‐up group: inflammatory background, the number of atypical cells, cell arrangement pattern, nuclear irregularity/grooves, hyperchromasia, and cell shape. RESULTS Among 30 women who had histologic follow‐up, 3 women (10%) had HSIL, and 13 women (43%) had low‐grade intraepithelial lesion (LSIL). Among 32 women who had cytologic follow‐up, 2 women (6%) had HSIL, 3 women (9%) had LSIL, 1 woman (3%) had ASC‐H, and 3 women (9%) had atypical squamous cells of undetermined significance (ASCUS). HPV was detected in 24 of 43 women (56%). The cytomorphologic features were similar in the SIL follow‐up group and the benign follow‐up group. No specific cytomorphologic features that predicted underlying SIL were identified. CONCLUSIONS ASC‐H in pregnant women had a lower predictive value for an underlying HSIL compared with the general population. A positive HPV test result was not a good indicator for an underlying SIL, but a negative result appeared to be useful for ruling out an underlying HSIL. Because of low positive predictive value for HSIL and the difficult colposcopic examination, a more conservative follow‐up may be reasonable for pregnant women who have a diagnosis of ASC‐H. HPV testing may be used as an adjunctive test. Cancer (Cancer Cytopathol) 2006 © 2006 American Cancer Society. The results of this study demonstrated a lower predictive value of the diagnosis of atypical squamous cells, cannot exclude high‐grade squamous intraepithelial lesion (ASC‐H) for an underlying squamous intraepithelial lesion in pregnant women compared with the general populatio