Atypical Squamous Cells of Undetermined Significance

Atypical Squamous Cells (ASC) are detected in 4.4% of all smears.

Atypical Squamous Cells (ASC) are examined in 2 groups;

ASC-US: Atypical Squamous Cells of Undetermined Significance
ASC-H: Atypical Squamous Cells where high-grade lesion cannot be excluded
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The incidence rate of CIN 2-3 in ASC-US is 5-17%

The incidence rate of CIN 2-3 in ASC-H is 24-94%.

Follow-up and treatment of a patient detected as ASC-H should be done as with HSIL.

Invasive cancer transformation in the presence of ASC-US is 0.1-0.2%.

If CIN is not detected in the presence of ASC-US, diagnostic excisional surgical procedures (Biopsy-LEEP and Conization) are not recommended.

In patients for whom ASC-US is reported In the follow-up;

Taking two consecutive PAP smears at 6-month intervals
HPV DNA test
If HPV DNA (+) is present, a one-time Colposcopy is recommended.

ASC-US FOLLOW-UP AND TREATMENT IN CASES

In ASC-US, PAP smears are taken twice with an interval of 6 months. If the second PAP smear is negative, annual follow-up is recommended.
If the HPV DNA test is negative, it is recommended to take a PAP smear at the 12th month.
If HPV DNA is positive, it is managed in the same way as LSIL and Colposcopy is recommended.
PAP smear is performed twice with an interval of 6 months. If ASC-US recurs multiple times, Colposcopy is recommended.
Surgical excisional procedures (LEEP-Conization) are not recommended in ASC-US.
Colposcopy is not recommended if there is no HPV DNA test and no lesion under the age of 20.

ASC-US in ADELÖSAN patients under the age of 20 MANAGEMENT

If ASC-US is present, repeat PAP smear in the 12th month,
HSIL and above lesion in repeat PAP smear If present, Colposcopy is recommended.
In cases where ASC-US or LSIL is detected, if the lesion recurs or progresses after 24 months, Colposcopy is recommended.

ASC-US MANAGEMENT DURING PREGNANCY

Follow-up in pregnant women over the age of 20 with ASC-US detected is the same as in non-pregnant women

Pregnancy In cases where ASC-US is detected and require Colposcopy – LEEP and ECC (endo cervical curettage), these surgical procedures should be postponed until the sixth postpartum week.

ASC- H CASES

They are followed up like patients diagnosed with HSIL.
ASC-H cases should be referred directly to Colposcopy.
Cases in which CIN 2-3 is not detected in colposcopy should be tested for HPV DNA every 12 months. Follow-up with test is recommended.
6. Two consecutive PAP'smear tests are recommended in the 12th and 12th months.
Colposcopy is recommended for HPV DNA (+) or ASC-US and above lesions.
If HPV DNA (-) or 2 PAP tests are negative at 6-month intervals, the patient is included in the normal follow-up program.

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