ASCUS AND AGUS CRITERIA - IAC TASK-FORCE SUMMARY

Issues The conference participants addressed the following issues: (1) reporting of equivocal diagnoses, (2) strategies to minimize the use of such diagnoses, (3) morphologic criteria, and (4) management of wom en with equivocal diagnoses. Consensus Position Equivocal diagnoses sh ould be minimized, to the extent possible, by emphasizing cytologist e ducation and training, improved specimen collection and quality assura nce monitoring of individual and laboratory diagnosis rates. Cases ful filling criteria for other diagnostic entities should not be included in the equivocal category. Regardless of the term utilized, an equivoc al diagnosis should be qualified in some manner to indicate that the d iagnosis defines a patient at increased risk of a lesion, particularly for those cases which raise concern about a possible high grade lesio n. Qualification of an equivocal diagnosis can also be accomplished by appending laboratory statistics of the likelihood of various clinical outcomes or recommendations for patient follow-up. In contrast to fav oring a reactive process versus squamous intraepithelial lesion (SIL), a more rationale approach to qualification of atypical squamous cells of undetermined significance may be to separate cases equivocal for l ow grade SIL from those suspicious for high grade SIL. With regard to glandular lesions, the conference participants expressed unanimous sup port for the separation of adenocarcinoma in situ (AIS) from atypical endocervical cells of undetermined significance when sufficient criter ia are present. However, the diagnosis of a precursor lesion to AIS, e ndocervical glandular dysplasia, was controversial. The majority of co nference participants discourage the use of such terms Its mild glandu lar dysplasia and low grade glandular dysplasia for cytologic diagnose s. Ongoing Issues Conference participants agreed that a term reflectin g diagnostic uncertainty is necessary to communicate findings that are equivocal. However, participants could not agree on the wording of su ch a term. Opinions differed as to: (1) use of atypical, abnormal or m orphologic changes to describe cell changes, (2) whether the diagnosis should indicate a squamous or glandular origin of the cells in questi on when this determination can be made, and (3) the value of defining morphologic criteria for such a diagnosis. The debate over terminology , Its well Its morphologic criteria, is ongoing, and the readership is invited to communicate opinions to Acta Cytologica. Management of wom en with equivocal diagnoses varies widely from locale to locale and ma y differ based on how the equivocal diagnosis is qualified. Findings i nsufficient for the diagnosis of a high grade lesion may warrant more aggressive follow-up than cases equivocal for a low grade lesion. Wher e sensitivity of detection of lesions is of paramount importance, foll ow-up will generally consist of more frequent cytology screening or co lposcopy and biopsy. However, in some countries it is considered uneth ical to have it high percentage of false positive diagnoses, which res ult in overtreatment and an unnecessary burden for women participating in cervical screening. Future studies may provide a morphologic, or p erhaps molecular, basis for distinguishing true precursors of neoplasi a from minor lesions of no significant clinical import; this would all ow a more coherent and rational approach to diagnosis and management o f women with equivocal cytologic findings.