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Int J Clin Exp Pathol 2012;5(5):428-435

Original Article
Atypical squamous cells of undetermined significance in patients with HPV positive DNA
testing and correlation with disease progression by age group: an institutional

Erika F Rodriguez, Jordan P Reynolds, Sarah M Jenkins, Stephanie M Winter, Michael R Henry, Aziza Nassar

Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Biomedical Statistics and Informatics, Mayo Clinic,
Rochester, MN, USA.

Received April 22, 2012; accepted May 17, 2012; Epub May 23, 2012; Published June 30, 2012

Abstract: Atypical squamous cells of undetermined significance (ASC-US) is a broad diagnostic category that could be attributed to human
papillomavirus infection (HPV), malignant neoplasia and reactive conditions. We evaluated our institutional experience with ASC-US in women
who are positive for high risk HPV (HRHPV+) by the Digene hybrid capture method from 2005-2009 to identify the risk of progression to
squamous intraepithelial lesion (SIL) and cervical intraepithelial neoplasia (CIN) in association with age. We reviewed cytologic and follow-up
surgical pathology reports for all specimens available. Progression was defined as a diagnosis of at least CINI on follow-up biopsy or
resection or SIL on cytology. We identified 2613 cases and follow-up was available in 1839 (70.4%). Of these 74.2% had just one follow-up,
16.2% had a total of 2 follow-ups, 5.3% had a total of 3 follow-ups, and the remaining had as many as 6 follow-ups. Among the 1839 patients,
69.4% were age 30 or younger, 16.0% were between 31 to 40, 9.0% were between 41 to 50, and 5.6% were 51 or older. Among these, 25-30%
progressed to dysplasia. The risk of progression varied by age (p=0.04) and was lowest among women between the ages of 41-50. Our
findings highlight the importance of continued cytologic follow-up in women with HRHPV+ ASC-US in order to detect progression of disease,
although the risk of progression is age dependent. (IJCEP1204010)

Keywords: ASC-US, Pap smear, HPV, Digene hybrid capture, cervical cytology

Address all correspondence to:
Dr. Aziza Nassar
Department of Laboratory Medicine and Pathology
Mayo Clinic, Hilton 11th Building, 200 First street, SW
Rochester, MN 55905, USA.
Tel: 507-5384679; Fax: 507-284-1599
E-mail: nassar.aziza@mayo.edu