Significance of a diagnosis of atypical squamous cells of undetermined significance for Papanicolaou smears in perimenopausal and postmenopausal women

Citation
Jt. Keating et Hh. Wang, Significance of a diagnosis of atypical squamous cells of undetermined significance for Papanicolaou smears in perimenopausal and postmenopausal women, CANC CYTOP, 93(2), 2001, pp. 100-105
Citations number
16
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Oncology,"Onconogenesis & Cancer Research
Journal title
CANCER CYTOPATHOLOGY
ISSN journal
0008-543X → ACNP
Volume
93
Issue
2
Year of publication
2001
Pages
100 - 105
Database
ISI
SICI code
0008-543X(20010425)93:2<100:SOADOA>2.0.ZU;2-6
Abstract
BACKGROUND. The current study was conducted to determine the significance o f a diagnosis of atypical squamous cells of undetermined significance (ASCU S) in perimenopausal and postmenopausal women. METHODS, The reports for all Papanicolaou (Pap) smears viewed in the study institution's cytology laboratory over a B-month period were reviewed. Wome n were divided into premenopausal (age less than or equal to 45 years), per imenopausal (ages 46-54 years), and postmenopausal (age greater than or equ al to 55 years) categories. Slide review and 2-year follow-up were obtained for selected cases diagnosed as ASCUS. ASCUS cases among the perimenopausa l women were compared with an age-matched control group. RESULTS. The total number of abnormal Pap smears in the premenopausal, peri menopausal, and postmenopausal categories were 770 (6.8%), 104 (4.3%), and 67 (2.9%), with 482, 83, and 41 diagnoses of ASCUS, respectively. The ratio of ASCUS to squamous intraepithelial lesions (SIL) was 2.2 overall and 1.9 , 7.5, and 4.1, respectively, for each group (P < 0.001). The positive pred ictive value for a diagnosis of SIL on subsequent Pap smears or biopsies wa s 22%, 12.2%, and 29.7%, respectively. Slide review showed that the premeno pausal ASCUS cases appeared to have a higher percentage of nuclear-cytoplas mic ratio increase and nuclear membrane irregularities compared with the ot her categories (P = 0.03 and P = 0.02, respectively) and the perimenopausal group was found to have more ASCUS in metaplastic cells (P = 0.03). In per imenopausal women, slides diagnosed as ASCUS demonstrated more air-drying a rtifact than the control group (P = 0.004) but had less obvious atrophy (P = 0.01). CONCLUSIONS. Despite a decreased abnormality rate with increasing age, the results of the current study show that the perimenopausal and postmenopausa l groups appear to have elevated ASCUS-to-SIL ratios. ASCUS appears to have a particularly low positive predictive value for SIL in perimenopausal wom en, and therefore most likely is overcalled in this age group. This may be attributable in part to air-drying artifact and subtle atrophic changes. Ca ncer (Cancer Cytopathol) 2001;93:100-105. (C) 2001 American Cancer Society.