“Three-Step Approach” Versus “See-and-Treat Procedure” in women with “High Grade Squamous Intraepithelial Lesion” (HSIL) or “Atypical Squamous Cells cannot exclude HSIL” (ASC-H) Cytology

Objective: The purpose of this study was to examine the correlation between histological findings in women with HSIL or ASC-H who have undergone loop electrosurgical excisional procedure with “Three-Step Approach” and “See-and-Treat Procedure".Study Design: A retrospective review was performed in 171 women with cytologically detected HSIL or ASC-H. Sixty five women with HSIL cytology and 35 women with ASC-H cytology were managed by “Three-Step Approach”, 35 women with ASC-H and 36 women with HSIL cytology were managed by "See-and-Treat Procedure”. Rates of histopathological findings were compared in two strategies with respect to previous cytology.Results: Fifteen women with ASC-H (42.9%), and 24 women with HSIL (68.5%) had CIN 2-3 at loop electrosurgical excisional procedure specimens in the “See-and-Treat” group whereas 14 women with ASC-H (38.8%), and 43 women with HSIL (66.2%) had CIN 2-3 at loop electrosurgical excisional procedure specimens in the “Three-Step Approach” group. There was no significant difference in the rate of CIN 2+ lesions when two strategies were compared in women with HSIL and ASC-H (p=0.71 and p=0.72, respectively). The overtreatment rates were 22.9% and 48.6% for HSIL and ASC-H cytology, respectively in the “See and Treat” group.Conclusion: In the ASC-H group, the rate of CIN 2+ lesions is significantly high (51.4%). It seems rational to perform “See-and-Treat procedure” in the setting of ASC-H smears although the overtreatment rate seems to be high. Because of the rate of overtreatment, the “Three-Step Approach” seems to be more reasonable in women with ASC-H cytology who also have fertility concerns. After a cytological diagnosis of HSIL, “see and treat” approach seems to be a safe and time saving strategy.

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Atypical Squamous Cells, Cannot Exclude High-Grade Squamous Intraepithelial Lesion: Concordance, High-Risk Human Papillomavirus status, and Positive Predictive Value

Journal of the American Society of Cytopathology ◽

10.1016/j.jasc.2015.09.060 ◽

2015 ◽

Vol 4 (6) ◽

pp. S25-S26

Author(s):

Mansooreh Eghtesadghalati ◽

Ruth Dietrich ◽

Erin Tank ◽

Michelle Kanter ◽

John Groth ◽

...

Keyword(s):

Human Papillomavirus ◽

High Risk ◽

Positive Predictive Value ◽

Predictive Value ◽

High Grade ◽

Squamous Intraepithelial Lesion ◽

Squamous Cells ◽

Intraepithelial Lesion

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Is Atypical Squamous Cells That Cannot Exclude High-grade Squamous Intraepithelial Lesion Clinically Significant?

Journal of Lower Genital Tract Disease ◽

10.1097/01.lgt.0000245039.45094.9a ◽

2007 ◽

Vol 11 (2) ◽

pp. 86-89 ◽

Cited By ~ 17

Author(s):

Michael T. McHale ◽

Jessica Souther ◽

John C. Elkas ◽

Bradley J. Monk ◽

Terry A. Harrison

Keyword(s):

High Grade ◽

Squamous Intraepithelial Lesion ◽

Squamous Cells ◽

Intraepithelial Lesion ◽

Clinically Significant

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Low-Grade Squamous Intraepithelial Lesion or High-Grade Squamous Intraepithelial Lesion? Concordance Between the Interpretation of Low-Grade Squamous Intraepithelial Lesion and High-Grade Squamous Intraepithelial Lesion in Papanicolaou Tests: Results From the College of American Pathologists PAP Education Program

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2018-0003-cp ◽

2018 ◽

Vol 143 (1) ◽

pp. 81-85 ◽

Cited By ~ 2

Author(s):

Barbara A. Crothers ◽

Mohiedean Ghofrani ◽

Chengquan Zhao ◽

Leslie G. Dodd ◽

Kelly Goodrich ◽

...

Keyword(s):

Education Program ◽

Repeated Measures ◽

False Negative ◽

Misclassification Rate ◽

Low Grade ◽

High Grade ◽

Squamous Intraepithelial Lesion ◽

Significant Difference ◽

Intraepithelial Lesion ◽

Diagnostic Concordance

Context.— Obtaining diagnostic concordance for squamous intraepithelial lesions in cytology can be challenging. Objective.— To determine diagnostic concordance for biopsy-proven low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL) Papanicolaou test slides in the College of American Pathologists PAP Education program. Design.— We analyzed 121 059 responses from 4251 LSIL and HSIL slides for the interval 2004 to 2013 using a nonlinear mixed-model fit for reference diagnosis, preparation type, and participant type. We evaluated interactions between the reference diagnosis and the other 2 factors in addition to a repeated-measures component to adjust for slide-specific performance. Results.— There was a statistically significant difference between misclassification of LSIL (2.4%; 1384 of 57 664) and HSIL (4.4%; 2762 of 63 395). There was no performance difference between pathologists and cytotechnologists for LSIL, but cytotechnologists had a significantly higher HSIL misclassification rate than pathologists (5.5%; 1437 of 27 534 versus 4.0%; 1032 of 25 630; P = .01), and both were more likely to misrepresent HSIL as LSIL (P < .001) than the reverse. ThinPrep LSIL slides were more likely to be misclassified as HSIL (2.4%; 920 of 38 582) than SurePath LSIL slides (1.5%; 198 of 13 196), but conventional slides were the most likely to be misclassified in both categories (4.5%; 266 of 5886 for LSIL, and 6.5%; 573 of 8825 for HSIL). Conclusions.— More participants undercalled HSIL as LSIL (false-negative) than overcalled LSIL as HSIL (false-positive) in the PAP Education program, with conventional slides more likely to be misclassified than ThinPrep or SurePath slides. Pathologists and cytotechnologists classify LSIL equally well, but cytotechnologists are significantly more likely to undercall HSIL as LSIL than are pathologists.

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