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Atypical Squamous Cells of Undetermined SignificanceAka: Pap Smear Atypia, ASCUS, ASC-US, ASC-H

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  1. Background: ASCUS Pap (Now ASC-US or ASC-H)
    1. ASCUS Pap now divided into 2 categories
      1. Atypical Squamous Cells, Cannot exclude HSIL (ASC-H)
        1. Higher risk - requires Colposcopy
        2. Accounts for 10% of ASCUS cases
      2. Atypical Squamous Cells undetermined signif. (ASC-US)
        1. Can be managed below (as per prior ASCUS guideline)
        2. Accounts for 90% of ASCUS cases
    2. ASCUS Pap should be followed closely
      1. ASCUS most common abnormality before HGSIL or cancer
      2. Kinney (1998) Obstet Gynecol 91:973
  2. Management: Initial ASC-US Pap Smear (choose 1 option)
    1. Options for ASC-US (All ASC-H require Colposcopy)
      1. Option 1: Send liquid pap on for HPV DNA Test
        1. Based on Vira-Pap (Human Papilloma Virus Test)
          1. Colposcopy if positive for high risk HPV
          2. (2003) Am J Obstet Gynecol 188:1383
        2. HPV positive for low risk type: Pap Smear in 1 year
        3. HPV posiitve for high risk type: Colposcopy
      2. Option 2: Repeat Pap Smear in 4-6 months
        1. Abnormal: Colposcopy
        2. Normal: Repeat pap in 4-6 months
          1. Pap Smear normal: Colposcopy
          2. Pap Smear negative: Pap Smear annually
      3. Option 3: Colposcopy
        1. See Colposcopy Protocol
    2. Special Circumstances
      1. Pregnancy
        1. Manage the same as non-pregnant patients
      2. Post-Menopausal
        1. Option 1: Colposcopy
        2. Option 2: HPV DNA Testing
        3. Option 3: Trial of intravaginal Estrogen
          1. Use if signs of atrophy and no contraindication
          2. Repeat Pap Smear one week after Estrogen done
            1. Normal: Pap Smear in 4-6 months, then yearly
            2. ASCUS or CIN: Colposcopy
  3. Management: Colposcopy evaluation of ASCUS
    1. See Colposcopy Protocol
  4. References
    1. Apgar (1999) Am Fam Physician 59(10):2794
    2. Apgar (2004) Am Fam Physician 70:1905
    3. Brotzman (1996) Am Fam Physician 53(4):1154
    4. Stack (1997) Postgrad Med 101(4):207
    5. Wright (2002) J Low Genit Tract Dis 6:127

Atypical squamous cells of uncertain significance (C0521184)

ConceptsCell (T025)
EnglishASCUS, Atypical Squamous Cell of Uncertain Significance, Atypical Squamous Cell of Undetermined Significance, Atypical squamous cells of uncertain significance, Atypical squamous cells of undetermined significance
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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