ATYPICAL REPARATIVE CHANGE ON CERVICAL VAGINAL SMEARS MAY BE ASSOCIATED WITH DYSPLASIA/

The Bethesda System for classifying cervical/vaginal smears has divide d reparative changes into two categories: typical and atypical. Althou gh atypical repair may be grouped with atypical squamous cells of unkn own significance (ASCUS), this study selected cases specifically diagn osed as atypical reparative changes (ARC), which showed streaming shee ts of cells and enlarged nuclei with nucleoli and anisonucleosis. Our goal was to determine the validity of grouping atypical repair with AS CUS. All cases were received by the Medical College of Virginia-Virgin ia Commonwealth University (MCV-VCU) pathology department in a 6-month period in 1993. Of 196 cases, 55 (28%) were biopsied within a subsequ ent 3-6-month period. Of these, 27 also carried a diagnosis of ASCUS ( 9), low-grade squamous intraepithelial lesion (LGSIL) (15), or high-gr ade squamous intraepithelial lesion (HGSIL) (3). The remaining 28 were presumably biopsied on the basis of clinical concern regarding a diag nosis of ARC. This group, which represents only 14% of the total with the ARC diagnosis, showed a spectrum of histologic changes from squamo us metaplasia and chronic cervicitis to HGSIL. Surprisingly, 25% of th ese patients (7 of 28) showed changes of LGSIL or higher, including 2 (7%) showing HGSIL. This level of higher grade histologic findings jus tifies separation of atypical from typical repair. Although there are some cases with a significant histologic abnormality found with a cyto logic diagnosis of ARC, the percentage of cases is not nearly as high as the 60% range seen associated with the diagnosis of ASCUS. Due to t he lack of consensus on the clinical management of ASCUS, we find no j ustification to separate the diagnosis of ARC from that of ASCUS. (C) 1996 Wiley-Liss, Inc.