{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T11:16:55Z","timestamp":1785842215058,"version":"3.56.0"},"reference-count":44,"publisher":"Archives of Pathology and Laboratory Medicine","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,7]]},"abstract":"<jats:title\/>\n                  <jats:p>\n                    <jats:italic>Context<\/jats:italic>\n                    .\u2014Previous work has reported that most high-grade cervical neoplasia is seen in patients with preceding Papanicolaou test results of atypical squamous cells of undetermined significance. This information was based on conventional test results and the Bethesda 1991 reporting system and was determined before the current treatment guidelines.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Objective<\/jats:italic>\n                    .\u2014Our objective was to perform a retrospective review of all histologically confirmed, high-grade cervical neoplasia to determine the diagnosis of the preceding liquid-based Papanicolaou test.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Design<\/jats:italic>\n                    .\u2014A total of 189 histologically confirmed, high-grade cervical intraepithelial neoplasia (CIN) cases grade 2 and greater were identified for a 1-year period.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Results<\/jats:italic>\n                    .\u2014Of the 189 cases, 10 (5.3%) had a previous diagnosis of atypical squamous cells of undetermined significance; 55 (29.1%) had low-grade squamous intraepithelial lesions; 31 (16.4%) had low-grade squamous intraepithelial lesions, unable to rule out a high-grade squamous intraepithelial lesion; 21 (11.1%) had atypical squamous cells, unable to rule out a high-grade squamous intraepithelial lesion; 68 (36%) had high-grade squamous intraepithelial lesions; 1 (0.5%) had atypical glandular cells; 1 (0.5%) had adenocarcinoma in situ; and 2 (1%) had invasive carcinoma. Combined \u201clow grade\u201d Papanicolaou test results (atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion) preceded 51 of 103 cases of CIN 2 (49.5%) and 14 of 103 cases (13.6%) of CIN 3\/cancer, whereas \u201chigh grade\u201d Papanicolaou test results (atypical squamous cells, unable to rule out a high-grade squamous intraepithelial lesion; low-grade squamous intraepithelial lesions, unable to rule out a high-grade squamous intraepithelial lesion; high-grade squamous intraepithelial lesions; atypical glandular cells; adenocarcinoma in situ; and invasive carcinoma) preceded 52 of 103 CIN 2 cases (50.5%) and 72 of 103 CIN 3\/cancer cases (69.9%).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusions<\/jats:italic>\n                    .\u2014Our data show that we can now more-reliably predict high-grade dysplasia on routine Papanicolaou tests. Only a small fraction of histologically confirmed CIN 2\/3 cases are found following a Papanicolaou test diagnosis of atypical squamous cells of undetermined significance.\n                  <\/jats:p>","DOI":"10.5858\/arpa.2012-0358-oa","type":"journal-article","created":{"date-parts":[[2012,9,20]],"date-time":"2012-09-20T10:36:54Z","timestamp":1348137414000},"page":"936-941","source":"Crossref","is-referenced-by-count":3,"title":["Only a Small Fraction of High-Grade Cervical Lesions Are Discovered After an Interpretation of Atypical Squamous Cells of Undetermined Significance When Using Imager-Assisted, Liquid-Based Papanicolaou Tests and the Bethesda 2001 System"],"prefix":"10.5858","volume":"137","author":[{"given":"Kelly A.","family":"Khan","sequence":"first","affiliation":[{"name":"From the Department of Pathology and Genomic Medicine, The Methodist Hospital and Weill Medical College of Cornell University, Houston, Texas."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debora A.","family":"Smith","sequence":"additional","affiliation":[{"name":"From the Department of Pathology and Genomic Medicine, The Methodist Hospital and Weill Medical College of Cornell University, Houston, Texas."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Thrall","sequence":"additional","affiliation":[{"name":"From the Department of Pathology and Genomic Medicine, The Methodist Hospital and Weill Medical College of Cornell University, Houston, Texas."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3906","reference":[{"issue":"2","key":"i1543-2165-137-7-936-b01","series-title":"CA Cancer J Clin","first-page":"105","article-title":"Cervical cancer screening rates in the United States and the potential impact of implementation of screening guidelines","volume":"57","author":"Solomon\n              D,","year":"2007","unstructured":"Solomon\n              D, \n            \n              Breen\n              N, \n            \n              McNeel\n              T. \n          \n          Cervical cancer screening rates in the United States and the potential impact of implementation of screening guidelines. CA Cancer J Clin. 2007;57(2):105\u2013111."},{"issue":"7","key":"i1543-2165-137-7-936-b02","series-title":"JAMA","first-page":"931","article-title":"The 1988 Bethesda System for reporting cervical\/vaginal cytological diagnoses","volume":"262","year":"1989","unstructured":"American Medical Association. The 1988 Bethesda System for reporting cervical\/vaginal cytological diagnoses. JAMA. 1989;262(7):931\u2013934."},{"issue":"16","key":"i1543-2165-137-7-936-b03","series-title":"JAMA","first-page":"2114","article-title":"Forum Group Members, Bethesda 2001 Workshop. The 2001 Bethesda System: terminology for reporting results of cervical cytology","volume":"287","author":"Solomon\n              D,","year":"2002","unstructured":"Solomon\n              D, \n            \n              Davey\n              D, \n            \n              Kurman\n              R, \n            et al;\n          \n          Forum Group Members, Bethesda 2001 Workshop. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA. 2002;287(16):2114\u20132119."},{"issue":"6","key":"i1543-2165-137-7-936-b04","series-title":"Cancer","first-page":"319","article-title":"ASCUS! ASCUS! down the rabbit hole","volume":"87","author":"Frable\n              WJ.","year":"1999","unstructured":"Frable\n              WJ. \n          \n          ASCUS! ASCUS! down the rabbit hole. 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Cancer. 2002;96(3):128\u2013134."},{"issue":"6","key":"i1543-2165-137-7-936-b06","series-title":"Obstet Gynecol","first-page":"973","article-title":"Where's the high-grade cervical neoplasia? the importance of minimally abnormal Papanicolaou diagnoses","volume":"91","author":"Kinney\n              WK,","year":"1998","unstructured":"Kinney\n              WK, \n            \n              Manos\n              MM, \n            \n              Hurley\n              LB, \n            \n              Ransley\n              JE. \n          \n          Where's the high-grade cervical neoplasia? the importance of minimally abnormal Papanicolaou diagnoses. Obstet Gynecol. 1998;91(6):973\u2013976."},{"issue":"4","key":"i1543-2165-137-7-936-b07","series-title":"J Natl Cancer Inst","first-page":"293","article-title":"ALTS Study group. 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Am J Clin Pathol. 2008;129(1):97\u2013101."},{"issue":"3","key":"i1543-2165-137-7-936-b10","series-title":"Diagn Cytopathol","first-page":"153","article-title":"Long-term follow-up of women with atypical squamous cells of undetermined significance (ASCUS)","volume":"27","author":"Emerson\n              RE,","year":"2002","unstructured":"Emerson\n              RE, \n            \n              Puzanov\n              A, \n            \n              Brunnemer\n              C, \n            \n              Younger\n              C, \n            \n              Cramer\n              H. \n          \n          Long-term follow-up of women with atypical squamous cells of undetermined significance (ASCUS). Diagn Cytopathol. 2002;27(3):153\u2013157."},{"issue":"3","key":"i1543-2165-137-7-936-b11","series-title":"Am J Obstet Gynecol","first-page":"396","article-title":"Managing atypical squamous cells of undetermined significance (ASCUS): Human papillomavirus testing, ASCUS subtyping, or follow-up cytology?","volume":"186","author":"Hughes\n              SA,","year":"2002","unstructured":"Hughes\n              SA, \n            \n              Sun\n              D, \n            \n              Gibson\n              C, \n            et al\n          . 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CIN\n            \n          \n          2\/3 and cervical cancer in an organised screening programme after an unsatisfactory or a normal pap smear: A seven-year prospective study of the Norwegian population-based screening programme. J Med Screen. 2004;11(2):70\u201376."},{"issue":"2","key":"i1543-2165-137-7-936-b13","series-title":"Diagn Cytopathol","first-page":"138","article-title":"Smears diagnosed as ASCUS: interobserver variation and follow-up","volume":"25","author":"Gatscha\n              RM,","year":"2001","unstructured":"Gatscha\n              RM, \n            \n              Abadi\n              M, \n            \n              Babore\n              S, \n            \n              Chhieng\n              D, \n            \n              Miller\n              MJ, \n            \n              Saigo\n              PE. \n          \n          Smears diagnosed as ASCUS: interobserver variation and follow-up. Diagn Cytopathol. 2001;25(2):138\u2013140."},{"issue":"11","key":"i1543-2165-137-7-936-b14","series-title":"Arch Pathol Lab Med","first-page":"1224","article-title":"Bethesda 2001 implementation and reporting rates: 2003 practices of participants in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology","volume":"128","author":"Davey\n              DD,","year":"2004","unstructured":"Davey\n              DD, \n            \n              Neal\n              MH, \n            \n              Wilbur\n              DC, \n            \n              Colgan\n              TJ, \n            \n              Styer\n              PE, \n            \n              Mody\n              DR. \n          \n          Bethesda 2001 implementation and reporting rates: 2003 practices of participants in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology. 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Accessed June 2, 2012."},{"issue":"8","key":"i1543-2165-137-7-936-b20","series-title":"Arch Pathol Lab Med","first-page":"1290","article-title":"Human papillomavirus testing and reporting rates: practices of participants in the College of American Pathologists Interlaboratory Comparison Program in Gynecologic Cytology in 2006","volume":"132","author":"Moriarty\n              AT,","year":"2008","unstructured":"Moriarty\n              AT, \n            \n              Schwartz\n              MR, \n            \n              Eversole\n              G, \n            et al\n          . Human papillomavirus testing and reporting rates: practices of participants in the College of American Pathologists Interlaboratory Comparison Program in Gynecologic Cytology in 2006. 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Cancer Treat Rev. 2009;35(3):210\u2013220."},{"issue":"3","key":"i1543-2165-137-7-936-b22","series-title":"Am J Clin Pathol","first-page":"395","article-title":"Conjunctive p16INK4a testing significantly increases accuracy in diagnosing high-grade cervical intraepithelial neoplasia","volume":"133","author":"Bergeron\n              C,","year":"2010","unstructured":"Bergeron\n              C, \n            \n              Ordi\n              J, \n            \n              Schmidt\n              D, \n            et al\n          . Conjunctive p16INK4a testing significantly increases accuracy in diagnosing high-grade cervical intraepithelial neoplasia. Am J Clin Pathol. 2010;133(3):395\u2013406."},{"issue":"2","key":"i1543-2165-137-7-936-b01","series-title":"CA Cancer J Clin","first-page":"105","article-title":"Cervical cancer screening rates in the United States and the potential impact of implementation of screening guidelines","volume":"57","author":"Solomon\n              D,","year":"2007","unstructured":"Solomon\n              D, \n            \n              Breen\n              N, \n            \n              McNeel\n              T. \n          \n          Cervical cancer screening rates in the United States and the potential impact of implementation of screening guidelines. CA Cancer J Clin. 2007;57(2):105\u2013111."},{"issue":"7","key":"i1543-2165-137-7-936-b02","series-title":"JAMA","first-page":"931","article-title":"The 1988 Bethesda System for reporting cervical\/vaginal cytological diagnoses","volume":"262","year":"1989","unstructured":"American Medical Association. 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Diagn Cytopathol. 2001;25(2):138\u2013140."},{"issue":"11","key":"i1543-2165-137-7-936-b14","series-title":"Arch Pathol Lab Med","first-page":"1224","article-title":"Bethesda 2001 implementation and reporting rates: 2003 practices of participants in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology","volume":"128","author":"Davey\n              DD,","year":"2004","unstructured":"Davey\n              DD, \n            \n              Neal\n              MH, \n            \n              Wilbur\n              DC, \n            \n              Colgan\n              TJ, \n            \n              Styer\n              PE, \n            \n              Mody\n              DR. \n          \n          Bethesda 2001 implementation and reporting rates: 2003 practices of participants in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology. 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