Is it possible to define a better ASCUS class in cervicovaginal screening?A review of 187 cases

OBJECTIVE: To try to better define the cytologic diagnosis of atypical squa mous cells of undetermined significance (ASCUS) in a cervical screening pro tocol. STUDY DESIGN: Smears from 187 patients with cytologic diagnoses of ASCUS an d histologic or two years' cytologic/colposcopic follow-up were reviewed. W hen an ASCUS diagnosis was confirmed, it was done strictly on the basis of the morphologic criteria recommended by the Regione Emilia Romagna Screenin g Protocol in 1997, trying also to subclassify ASCUS into favor reactive or favor neoplasia. RESULTS: Seventy ASCUS cases were negative (37.4%). Three cases (1.6%) were low grade squamous intraepithelial lesion, and seven (3.8%) were high grad e squamous intraepithelial lesion. One hundred seven ASCUS cases (57.2%) we re confirmed. Among the 70 negative cases, 36 (51.4%) had reactive changes on biopsy, 30 (42.9%) koilocytosis, 3 cervical intraepithelial neoplasia (C IN 1) and one CIN not otherwise specified (5.7% total). CONCLUSION: Reclassification of ASCUS cases using tighter criteria reduced them to a rate of 57.2% but missed 30 patients with histologic diagnoses of koilocytosis and 4 with histologic diagnoses of CIN.