{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T07:04:19Z","timestamp":1760079859615},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2015,5,11]],"date-time":"2015-05-11T00:00:00Z","timestamp":1431302400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background.<\/jats:title>\n                  <jats:p>Current guidelines recommend initial colposcopy with biopsy regardless of human papillomavirus (HPV) test results in women with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H). The purpose of this study was to evaluate the value of HPV testing in women with ASC-H based on colposcopic pathology results.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods.<\/jats:title>\n                  <jats:p>A multicenter cross-sectional study was carried out at three academic hospitals and involved 40,847 Korean women who underwent cervical cancer screening with cytology and HPV tests with or without subsequent colposcopic biopsies between January 2007 and December 2013.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results.<\/jats:title>\n                  <jats:p>ASC-H was diagnosed in 276 women (0.7%). Only 6 of 68 (8.8%) women with ASC-H who were HPV negative had cervical intraepithelial neoplasia grade \u22652 (CIN \u22652) lesions, whereas 47.4% of the women with ASC-H who were HPV positive had CIN \u22652 lesions. No cases of invasive cervical cancer were diagnosed among women with ASC-H who were HPV negative. Logistic regression analysis was performed using the group with normal Papanicolaou test results and HPV-negative status as the reference group. Women with ASC-H who were HPV positive had a significantly increased risk of CIN \u22652 lesions, whereas no significant increase was observed in patients with ASC-H and HPV-negative status.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion.<\/jats:title>\n                  <jats:p>If the result of the HPV test was negative, the risk of CIN \u22652 lesions in Korean women with ASC-H cytology was low. Reflex HPV testing should be an option for the management of women with cytology showing ASC-H to decrease unnecessary colposcopic biopsies, which are expensive and invasive.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Implications for Practice:<\/jats:title>\n                  <jats:p>Current American Society for Colposcopy and Cervical Pathology guidelines recommend universal colposcopy for the management of women with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) on cytology, regardless of human papillomavirus (HPV) test results. The present study suggested that HPV cotesting in patients with ASC-H cytology can provide more detailed and useful information regarding the risk of high-grade cervical intraepithelial neoplasia (CIN) lesions and the need for further treatment. When the result of the HPV test was negative, the risk of CIN lesions of grade \u22652 in women with ASC-H cytology was low. Consequently, reflex HPV testing, rather than immediately performance of invasive and expensive colposcopy with biopsy, should be an option for the management of women with ASC-H.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1634\/theoncologist.2014-0459","type":"journal-article","created":{"date-parts":[[2015,5,12]],"date-time":"2015-05-12T02:31:54Z","timestamp":1431397914000},"page":"635-639","source":"Crossref","is-referenced-by-count":2,"title":["Reflex Human Papillomavirus Test Results as an Option for the Management of Korean Women With Atypical Squamous Cells Cannot Exclude High-Grade Squamous Intraepithelial Lesion"],"prefix":"10.1093","volume":"20","author":[{"given":"Ki-Jin","family":"Ryu","sequence":"first","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanghoon","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyung-Jin","family":"Min","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jae Won","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin Hwa","family":"Hong","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jae Yun","family":"Song","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jae Kwan","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nak Woo","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2015,5,11]]},"reference":[{"key":"2021122309232337100_B1","doi-asserted-by":"crossref","first-page":"69","DOI":"10.3322\/caac.20107","article-title":"Global cancer statistics","volume":"61","author":"Jemal","year":"2011","journal-title":"CA Cancer J Clin"},{"key":"2021122309232337100_B2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4143\/crt.2011.43.1.1","article-title":"Cancer statistics in Korea: Incidence, mortality, survival, and prevalence in 2008","volume":"43","author":"Jung","year":"2011","journal-title":"Cancer Res Treat"},{"key":"2021122309232337100_B3","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1634\/theoncologist.10-7-528","article-title":"Vaccines against human papillomavirus and cervical cancer: Promises and challenges","volume":"10","author":"Mahdavi","year":"2005","journal-title":"The Oncologist"},{"key":"2021122309232337100_B4","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1002\/dc.23173","article-title":"Clinical significance of HPV DNA cotesting in Korean women with ASCUS or ASC-H","volume":"42","author":"Lee","year":"2014","journal-title":"Diagn Cytopathol"},{"key":"2021122309232337100_B5","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1016\/S0140-6736(13)62218-7","article-title":"Efficacy of HPV-based screening for prevention of invasive cervical cancer: Follow-up of four European randomised controlled trials","volume":"383","author":"Ronco","year":"2014","journal-title":"Lancet"},{"key":"2021122309232337100_B6","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1097\/LGT.0b013e31824ca9d5","article-title":"American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer","volume":"16","author":"Saslow","year":"2012","journal-title":"J Low Genit Tract Dis"},{"key":"2021122309232337100_B7","doi-asserted-by":"crossref","first-page":"156","DOI":"10.12788\/jcso.0039","article-title":"Cobas HPV test for first-line screening for cervical cancer","volume":"12","author":"Abraham","year":"2014","journal-title":"J Community Support Oncol"},{"key":"2021122309232337100_B8","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1634\/theoncologist.2013-0340","article-title":"Current cervical cancer screening knowledge, awareness, and practices among U.S. affiliated Pacific Island providers: Opportunities and challenges","volume":"19","author":"Townsend","year":"2014","journal-title":"The Oncologist"},{"key":"2021122309232337100_B9","doi-asserted-by":"crossref","first-page":"4221","DOI":"10.7314\/APJCP.2012.13.9.4221","article-title":"Current status of knowledge, attitude and practice (KAP) and screening for cervical cancer in countries at different levels of development","volume":"13","author":"Raychaudhuri","year":"2012","journal-title":"Asian Pac J Cancer Prev"},{"key":"2021122309232337100_B10","doi-asserted-by":"crossref","first-page":"186","DOI":"10.3802\/jgo.2013.24.2.186","article-title":"Practice guidelines for the early detection of cervical cancer in Korea: Korean Society of Gynecologic Oncology and the Korean Society for Cytopathology 2012 edition","volume":"24","author":"Lee","year":"2013","journal-title":"J Gynecol Oncol"},{"key":"2021122309232337100_B11","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/1742-6413-3-14","article-title":"ASC-H in Pap test\u2014definitive categorization of cytomorphological spectrum","volume":"3","author":"Chivukula","year":"2006","journal-title":"Cytojournal"},{"key":"2021122309232337100_B12","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1007\/s00404-013-3015-5","article-title":"Cervical cytology with a diagnosis of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H): A follow-up study with corresponding histology and significance of predicting dysplasia by human papillomavirus (HPV) DNA testing","volume":"289","author":"Gilani","year":"2014","journal-title":"Arch Gynecol Obstet"},{"key":"2021122309232337100_B13","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1002\/dc.22982","article-title":"Clinical significance of atypical squamous cells cannot exclude high grade squamous intraepithelial lesion with histologic correlation-: A 9-year experience","volume":"41","author":"Selvaggi","year":"2013","journal-title":"Diagn Cytopathol"},{"key":"2021122309232337100_B14","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1309\/AJCPYK60BZRNNAHQ","article-title":"Follow-up outcomes in a large cohort of patients with human papillomavirus-negative ASC-H cervical screening test results","volume":"138","author":"Cohen","year":"2012","journal-title":"Am J Clin Pathol"},{"key":"2021122309232337100_B15","doi-asserted-by":"crossref","first-page":"2114","DOI":"10.1001\/jama.287.16.2114","article-title":"The 2001 Bethesda System: Terminology for reporting results of cervical cytology","volume":"287","author":"Solomon","year":"2002","journal-title":"JAMA"},{"issue":"(suppl 1)","key":"2021122309232337100_B16","doi-asserted-by":"crossref","first-page":"S69","DOI":"10.1097\/LGT.0b013e31828543b1","article-title":"Follow-up testing after colposcopy: Five-year risk of CIN 2+ after a colposcopic diagnosis of CIN 1 or less","volume":"17","author":"Katki","year":"2013","journal-title":"J Low Genit Tract Dis"},{"key":"2021122309232337100_B17","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1590\/1516-3180.2014.1321597","article-title":"Follow-up of women with atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions (ASC-H)","volume":"132","author":"L\u00f3pez-Alegr\u00eda","year":"2014","journal-title":"Sao Paulo Med J"},{"key":"2021122309232337100_B18","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1016\/S0002-9378(03)00413-7","article-title":"A randomized trial on the management of low-grade squamous intraepithelial lesion cytology interpretations","volume":"188","year":"2003","journal-title":"Am J Obstet Gynecol"},{"key":"2021122309232337100_B19","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1097\/LGT.0b013e3181ca66a6","article-title":"Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion: Review of ancillary testing modalities and implications for follow-up","volume":"14","author":"Davey","year":"2010","journal-title":"J Low Genit Tract Dis"},{"key":"2021122309232337100_B20","doi-asserted-by":"crossref","first-page":"1874","DOI":"10.5858\/132.12.1874","article-title":"Adjunctive human papillomavirus DNA testing is a useful option in some clinical settings for disease risk assessment and triage of females with ASC-H Papanicolaou test results","volume":"132","author":"Bandyopadhyay","year":"2008","journal-title":"Arch Pathol Lab Med"},{"key":"2021122309232337100_B21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/dc.20576","article-title":"Atypical squamous cells, cannot exclude high grade intraepithelial lesion (ASC-H): Does HPV matter?","volume":"35","author":"Reid-Nicholson","year":"2007","journal-title":"Diagn Cytopathol"},{"key":"2021122309232337100_B22","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1002\/dc.20497","article-title":"Reflex high-risk human papilloma virus DNA test is useful in the triage of women with atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion","volume":"34","author":"Wu","year":"2006","journal-title":"Diagn Cytopathol"},{"key":"2021122309232337100_B23","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/cncr.21388","article-title":"Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion: Diagnostic performance, human papillomavirus testing, and follow-up results","volume":"108","author":"Srodon","year":"2006","journal-title":"Cancer"},{"key":"2021122309232337100_B24","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1002\/cncr.21387","article-title":"Should women with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion, receive reflex human papillomavirus-DNA testing?","volume":"105","author":"Liman","year":"2005","journal-title":"Cancer"},{"key":"2021122309232337100_B25","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1634\/theoncologist.2014-0083","article-title":"Cervical cancer screening: The complex interplay of medical infrastructure, society, and culture","volume":"19","author":"Goodman","year":"2014","journal-title":"The Oncologist"}],"container-title":["The Oncologist"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1634\/theoncologist.2014-0459","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1634\/theoncologist.2014-0459","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/oncolo\/article-pdf\/20\/6\/635\/41870032\/oncolo_20_6_635.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/oncolo\/article-pdf\/20\/6\/635\/41870032\/oncolo_20_6_635.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,24]],"date-time":"2021-12-24T02:38:58Z","timestamp":1640313538000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/oncolo\/article\/20\/6\/635\/6399653"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,5,11]]},"references-count":25,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2015,5,11]]},"published-print":{"date-parts":[[2015,6,1]]}},"URL":"https:\/\/doi.org\/10.1634\/theoncologist.2014-0459","relation":{},"ISSN":["1083-7159","1549-490X"],"issn-type":[{"value":"1083-7159","type":"print"},{"value":"1549-490X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2015,6,1]]},"published":{"date-parts":[[2015,5,11]]}}}