Atypical Squamous Cells of Undetermined Significance

Aka: Atypical Squamous Cells of Undetermined Significance, Pap Smear Atypia, Cervical Cytology Atypia, ASCUS, ASC-US, ASC-H

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II. 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 Cervical Cancer
    2. Kinney (1998) Obstet Gynecol 91:973-6 [PubMed]

III. Management: 2019 Guidelines

  1. Colposcopy indications
    1. HPV Positive ASC-US Pap Smear
    2. ASC-H Pap Smear
  2. HPV Positive ASC-US Pap Smear
    1. Colposcopy biopsy <CIN 2: One year follow-up
    2. Year 1 follow-up HPV Positive ASC-US Pap Smear: One year follow-up
    3. Year 2 follow-up
      1. HPV Negative and No CIN: Three year follow-up
      2. HPV Positive ASC-US Pap Smear: Colposcopy

IV. Management: Age 21 to 24 years old with ASC-US or ASC-H Cervical Cytology (2014 Guidelines)

  1. Colposcopy for all ASC-H (cannot exclude HSIL)
    1. See HSIL for protocol
  2. ASC-US
    1. See Low Grade Squamous Intraepithelial Lesion (LSIL)
    2. Treated the same as LSIL in ages 21-24 years old

V. Management: Age over 25 years old and initial ASC-US Cervical Cytology (2014 Guidelines)

  1. Colposcopy for all ASC-H (cannot exclude HSIL)
    1. No CIN 2 or 3
      1. See CIN 1
    2. CIN 2, 3
      1. See CIN 2 or CIN 3
  2. Options for ASC-US
    1. Option 1: Send liquid pap on for HPV DNA Test (preferred)
      1. HPV negative (or positive for low risk type)
        1. Repeat cytology and HPV in 3 years (co-testing)
      2. HPV posiitve for high risk type
        1. Colposcopy
    2. Option 2: Repeat Cytology in 1 year
      1. Abnormal (AS-CUS or worse)
        1. Colposcopy
      2. Normal
        1. Repeat cytology in 3 years
  3. Special Circumstances
    1. Pregnancy
      1. Manage the same as non-pregnant patients (but no ECC and avoid biopsies if possible)
    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

VI. Management: Colposcopy evaluation of ASCUS

  1. See Colposcopy Protocol

VII. Resources

  1. (2014) ASCCP Guidelines
    1. http://www.asccp.org/Guidelines-2/Management-Guidelines-2
  2. (2019) ASCCP Guidelines
    1. https://www.asccp.org/management-guidelines

VIII. References

  1. Apgar (2009) Am Fam Physician 80(2): 147-55 [PubMed]
  2. Apgar (1999) Am Fam Physician 59(10):2794-800 [PubMed]
  3. Apgar (2004) Am Fam Physician 70:1905-16 [PubMed]
  4. Brotzman (1996) Am Fam Physician 53(4):1154-62 [PubMed]
  5. Stack (1997) Postgrad Med 101(4):207-4 [PubMed]
  6. Wright (2002) J Low Genit Tract Dis 6:127-43 [PubMed]

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Related Studies

Ontology: Atypical squamous cells of uncertain significance (C0521184)

Definition (NCI_NCI-GLOSS) Abnormal cells from the outer walls of the cervix (the lower, narrow end of the uterus). Abnormal squamous cells (thin, flat cells that look like fish scales) are found in a low number of Pap smears (a procedure used to detect cervical cancer) and may indicate infection with the human papillomavirus (HPV) or another infectious agent. The risk of developing cervical cancer is very low for patients with ASCUS without HPV infection.
Concepts Cell (T025)
MSH D065309
SnomedCT 39035006
English Atypical squamous cells of uncertain significance, ascus, atypical squamous cells of uncertain significance, Atypical Squamous Cells of Undetermined Significance, ASC-US, ASCUS, Atypical squamous cells of undetermined significance (morphologic abnormality), Atypical squamous cells of undetermined significance, Atypical Squamous Cell of Uncertain Significance, Atypical Squamous Cell of Undetermined Significance, atypical squamous cells of undetermined significance
Dutch ASC-US, atypische plaveiselcellen van ongekend belang
French Cellules épidermoïdes atypiques de signification indéterminée (ASCUS), Cellules épidermoïdes atypiques de signification non précisée
German ASC-US, atypische Plattenepithelzellen von ungeklaerter Bedeutung
Italian Cellule squamose atipiche di significato indeterminato (ASCUS), Cellule squamose atipiche di significato indeterminato
Portuguese ASC-US, Células escamosas atípicas de significado indeterminado
Spanish ASC-US, Células escamosas atípicas de significado indeterminado, alteraciones de células pavimentosas de significación indeterminada (ASCUS), células escamosas atípicas de significación indeterminada (ASCUS) (anomalía morfológica), células escamosas atípicas de significación indeterminada (ASCUS)
Japanese 意義不明異型扁平上皮細胞, ｲｷﾞﾌﾒｲｲｹｲﾍﾝﾍﾟｲｼﾞｮｳﾋｻｲﾎﾞｳ
Czech ASC-US, Atypické skvamózní buňky neurčitého významu
Hungarian Meghatározatlan jellegű atypusos squamosus sejtek, ASC-US
Derived from the NIH UMLS (Unified Medical Language System)

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