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Atypical Squamous Cells

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The Bethesda System for Reporting Cervical Cytology

Abstract

The TBS category of “atypical squamous cells (ASC)” derives from the concept that a significant number of cases show changes that, while abnormal, are morphologically insufficient for a definitive interpretation of either LSIL or HSIL. ASC is the most common abnormality reported on cervical cytology specimens. These equivocal specimens have a higher risk for follow-up findings of SIL than do negative cases and therefore it is important to include the ASC category in the Bethesda reporting system to maintain the sensitivity of the Pap test. In Bethesda 2014, ASC continues to be further subdivided into “Atypical squamous cells – undetermined significance (ASC-US)” and “Atypical squamous cells – a high grade squamous intraepithelial lesion cannot be excluded (ASC-H).” ASC-US comprises the predominance of ASC cases, and is broadly defined as those cases showing features suggestive of LSIL. ASC-H represents only a small minority of cases and includes cases suggestive of HSIL. This conceptual scheme is consistent with the dichotomous categorization of the more definitive categories of LSIL and HSIL, and relates to our current understanding of HPV biology and cervical carcinogenesis. This chapter includes numerous examples of each ASC entity and many of the reactive changes from which it should be distinguished.

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Author information

Authors and Affiliations

  1. Robert Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Fadi W. Abdul-Karim MD, MMed

  2. Division of Anatomic Pathology, Department of Pathology, Medical College of Virginia Hospitals, Virginia Commonwealth University, Gateway bldg, Room 6208, 1200 E. Marshall Street, Richmond, VA, 23298, USA

    Celeste N. Powers MD, PhD

  3. Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Dr., HG332, Stanford, CA, 94305, USA

    Jonathan S. Berek MD, MMS

  4. Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA

    Mark E. Sherman MD

  5. Department of Pathology, The George Washington University, 2120 L street, NW, Gelman Building, Suite 200, Washington, DC, 20037, USA

    Sana O. Tabbara MD

  6. Department of Pathology, MedStar Georgetown University Hospital, 3900 Reservoir Road, NW, Medical Dental Building SW210, Washington, DC, 20007, USA

    Mary K. Sidawy MD

Authors
  1. Fadi W. Abdul-Karim MD, MMed
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  2. Celeste N. Powers MD, PhD
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  3. Jonathan S. Berek MD, MMS
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  4. Mark E. Sherman MD
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  5. Sana O. Tabbara MD
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  6. Mary K. Sidawy MD
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Corresponding author

Correspondence to Mary K. Sidawy MD .

Editor information

Editors and Affiliations

  1. Department of Pathology, Northwestern Memorial Hospital, Chicago, Illinois, USA

    Ritu Nayar

  2. Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA

    David C. Wilbur

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Abdul-Karim, F.W., Powers, C.N., Berek, J.S., Sherman, M.E., Tabbara, S.O., Sidawy, M.K. (2015). Atypical Squamous Cells. In: Nayar, R., Wilbur, D. (eds) The Bethesda System for Reporting Cervical Cytology. Springer, Cham. https://doi.org/10.1007/978-3-319-11074-5_4

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  • DOI: https://doi.org/10.1007/978-3-319-11074-5_4

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-11073-8

  • Online ISBN: 978-3-319-11074-5

  • eBook Packages: MedicineMedicine (R0)

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