ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE QUALIFIED - A FOLLOW-UP-STUDY

The Bethesda System recommends that the diagnosis of ''atypical squamo us cells of undetermined significance'' (ASCUS) be qualified when poss ible to indicate whether a reactive process, or a squamous intraepithe lial lesion (SIL), is favored. In order to evaluate the utility of thi s recommendation, 308 cervicovaginal smears diagnosed as ASCUS favorin g a reactive (FR) or dysplastic (FD) process were identified. Concurre nt or follow-up biopsies and cervicovaginal smear results were reviewe d and compared to the follow-up of 103 cervicovaginal smears diagnosed as ASCUS without qualification. A follow-up diagnosis of SIL was foun d in 46.5%, 29.5%, and 26.2% of the ASCUS FD, ASCUS FR, and ASCUS unqu alified cases, respectively. A repeated ASCUS diagnosis was found in 2 0.4%, 21.8%, and 18.4% of the ASCUS FD, ASCUS FR, and ASCUS unqualifie d cases, respectively. Follow-up of each group was negative for dyspla sia in 30.0%, 48.7%, and 54.4% of the ASCUS FD, ASCUS FR, and ASCUS un qualified cases, respectively. These results support the use of an ASC US FD category for the increased detection of patients with dysplasia. The ASCUS FR category was not helpful in our laboratory. Follow-up st udies of qualified ASCUS cases in individual practice settings may be useful in guiding patient management. (C) 1996 Wiley-Liss, Inc.