BACKGROUND. Atypical squamous metaplastic (ASM) cells are associated with h
igh-grade squamous intraepithelial lesions (HGSIL) in many cases. The repro
ducibility of the diagnosis and biopsy follow-up results of cases designate
d as ASM were studied at Women and Infants' Hospital of Rhode Island.
METHODS, Of 180 patients with ASM who the authors examined from January 1,
1998 to September 30, 1998, 147 (81.7%) had subsequent biopsies. Results of
the biopsies were tallied. Twenty cases were rescreened in a blinded fashi
on to determine intra- and interobserver agreement and to identify diagnost
RESULTS. Sixty-five (44.2%) cases of ASM had HGSIL on biopsy, 26 (17.7%) ha
d low-grade squamous intraepithelial lesion, and 56 cases (38.1%) were beni
gn. Overall individual consistency is 8 of 16 (50%), and overall agreement
is 13 of 64 (20%).
CONCLUSIONS. Sixty-two percent of cases designated as ASM cytologically wer
e associated with SIL, primarily HGSIL, at biopsies. The findings underscor
e the importance of this subcategory of atypical squamous cells. However, p
oor reproducibility suggests the need for refined criteria and/or continuin
g education, and obtaining second opinion. Cancer (Cancer Cytopathol) 2001;
93:16-22, (C) 2001 American Cancer Society.