QUALIFYING THE CYTOLOGIC DIAGNOSIS OF ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE AFFECTS THE PREDICTIVE VALUE OF A SQUAMOUS INTRAEPITHELIAL LESION ON SUBSEQUENT BIOPSY

Objective.-To evaluate whether different qualifications of a cytologic diagnosis of ''atypical squamous cells of undetermined significance'' predict a greater or lesser likelihood of cervical pathology. Design. -Comparison of different cytologic qualifications of atypical squamous cells of undetermined significance with the frequency of significant cervical disease as documented by tissue biopsy. Participants and Sett ing.-Four hundred, fifty-two consecutive Papanicolaou smears showing a typical squamous cells of undetermined significance (diagnosed by nine cytopathologists) in women who had undergone cervical biopsy within t he previous 90 days at Brigham and Women's Hospital, Boston, Mass (Jan uary-June 1995). Main Outcome Measure.-The histopathologic diagnosis o f squamous intraepithelial lesion of the cervix. Results.-The 452 smea rs were qualified as ''favor reactive'' (22%), ''not otherwise specifi ed'' (42%), ''favor squamous intraepithelial lesion'' (29%), and ''fav or high-grade squamous intraepithelial lesion'' (6%). High-grade squam ous intraepithelial lesions and total squamous intraepithelial lesions were pathologically confirmed by cervical biopsy in 3.6% and 6% of th e favor reactive smears, in 11% and 21% of the not otherwise specified smears, in 12% and 30% of the favor squamous intraepithelial lesion s mears, and in 53% and 59% of the favor high-grade squamous intraepithe lial lesion smears. Significant associations were seen between a favor reactive smear and a benign finding on cervical biopsy (94%, P = .04) and between a favor high-grade squamous intraepithelial lesion smear and a biopsy that showed a high-grade squamous intraepithelial lesion (53%, P = .00001). Conclusions.-Qualifying atypical squamous cells of undetermined significance stratifies women into different risk groups for squamous intraepithelial lesion. It is reasonable for physicians t o make patient management decisions based, at least in part, on such q ualifications.