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Article: ASCUS and AGUS criteria: IAC task force summary

TitleASCUS and AGUS criteria: IAC task force summary
Authors
Issue Date1998
PublisherScience Printers and Publishers, Inc. The Journal's web site is located at http://www.acta-cytol.com
Citation
Acta Cytologica, 1998, v. 42 n. 1, p. 16-24 How to Cite?
AbstractIssues: The conference participants addressed the following issues: (1) reporting of equivocal diagnoses, (2) strategies to minimize the use of such diagnoses, (3) morphologic criteria, and (4) management of women with equivocal diagnoses. Consensus Position: Equivocal diagnoses should be minimized, to the extent possible, by emphasizing cytologist education and training, improved specimen collection and quality assurance monitoring of individual and laboratory diagnosis rates. Cases fulfilling criteria for other diagnostic entities should not be included in the equivocal category. Regardless of the term utilized, an equivocal diagnosis should be qualified in some manner to indicate that the diagnosis defines a patient at increased risk of a lesion, particularly for those cases which raise concern about a possible high grade lesion. Qualification of an equivocal diagnosis can also be accomplished by appending laboratory statistics of the likelihood of various clinical outcomes or recommendations for patient follow-up. In contrast to favoring a reactive process versus squamous intraepithelial lesion (SIL), a more rationale approach to qualification of atypical squamous cells of undetermined significance may be to separate cases equivocal for low grade SIL from those suspicious for high grade SIL. With regard to glandular lesions, the conference participants expressed unanimous support for the separation of adenocarcinoma in situ (AIS) from atypical endocervical cells of undetermined significance when sufficient criteria are present. However, the diagnosis of a precursor lesion to AIS, endocervical glandular dysplasia, was controversial. The majority of conference participants discourage the use of such terms as mild glandular dysplasia and low grade glandular dysplasia for cytologic diagnoses. Ongoing Issues: Conference participants agreed that a term reflecting diagnostic uncertainty is necessary to communicate findings that are equivocal. However, participants could not agree on the wording of such a term. Opinions differed as to: (1) use of atypical, abnormal or morphologic changes to describe cell changes, (2) whether the diagnosis should indicate a squamous or glandular origin of the cells in question when this determination can be made, and (3) the value of defining morphologic criteria for such a diagnosis. The debate over terminology, as well as morphologic criteria, is ongoing, and the readership is invited to communicate opinions to Acta Cytologica. Management of women with equivocal diagnoses varies widely from locale to locale and may differ based on how the equivocal diagnosis is qualified. Findings insufficient for the diagnosis of a high grade lesion may warrant more aggressive follow-up than cases equivocal for a low grade lesion. Where sensitivity of detection of lesions is of paramount importance, follow-up will generally consist of more frequent cytology screening or colposcopy and biopsy. However, in some countries it is considered unethical to have a high percentage of false positive diagnoses, which result in overtreatment and an unnecessary burden for women participating in cervical screening. Future studies may provide a morphologic, or perhaps molecular, basis for distinguishing true precursors of neoplasia from minor lesions of no significant clinical import; this would allow a more coherent and rational approach to diagnosis and management of women with equivocal cytologic findings.
Persistent Identifierhttp://hdl.handle.net/10722/148118
ISSN
2013 Impact Factor: 1.562
2015 SCImago Journal Rankings: 0.486
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorSolomon, Den_US
dc.contributor.authorFrable, WJen_US
dc.contributor.authorVooijs, GPen_US
dc.contributor.authorWilbur, DCen_US
dc.contributor.authorAmma, NSen_US
dc.contributor.authorCollins, RJen_US
dc.contributor.authorDavey, DDen_US
dc.contributor.authorKnight, BKen_US
dc.contributor.authorLuff, RDen_US
dc.contributor.authorMeisels, Aen_US
dc.contributor.authorNavin, Jen_US
dc.contributor.authorRosenthal, DLen_US
dc.contributor.authorSauer, Ten_US
dc.contributor.authorStoler, Men_US
dc.contributor.authorSuprun, HZen_US
dc.contributor.authorYamauchi, Ken_US
dc.date.accessioned2012-05-29T06:10:57Z-
dc.date.available2012-05-29T06:10:57Z-
dc.date.issued1998en_US
dc.identifier.citationActa Cytologica, 1998, v. 42 n. 1, p. 16-24en_US
dc.identifier.issn0001-5547en_US
dc.identifier.urihttp://hdl.handle.net/10722/148118-
dc.description.abstractIssues: The conference participants addressed the following issues: (1) reporting of equivocal diagnoses, (2) strategies to minimize the use of such diagnoses, (3) morphologic criteria, and (4) management of women with equivocal diagnoses. Consensus Position: Equivocal diagnoses should be minimized, to the extent possible, by emphasizing cytologist education and training, improved specimen collection and quality assurance monitoring of individual and laboratory diagnosis rates. Cases fulfilling criteria for other diagnostic entities should not be included in the equivocal category. Regardless of the term utilized, an equivocal diagnosis should be qualified in some manner to indicate that the diagnosis defines a patient at increased risk of a lesion, particularly for those cases which raise concern about a possible high grade lesion. Qualification of an equivocal diagnosis can also be accomplished by appending laboratory statistics of the likelihood of various clinical outcomes or recommendations for patient follow-up. In contrast to favoring a reactive process versus squamous intraepithelial lesion (SIL), a more rationale approach to qualification of atypical squamous cells of undetermined significance may be to separate cases equivocal for low grade SIL from those suspicious for high grade SIL. With regard to glandular lesions, the conference participants expressed unanimous support for the separation of adenocarcinoma in situ (AIS) from atypical endocervical cells of undetermined significance when sufficient criteria are present. However, the diagnosis of a precursor lesion to AIS, endocervical glandular dysplasia, was controversial. The majority of conference participants discourage the use of such terms as mild glandular dysplasia and low grade glandular dysplasia for cytologic diagnoses. Ongoing Issues: Conference participants agreed that a term reflecting diagnostic uncertainty is necessary to communicate findings that are equivocal. However, participants could not agree on the wording of such a term. Opinions differed as to: (1) use of atypical, abnormal or morphologic changes to describe cell changes, (2) whether the diagnosis should indicate a squamous or glandular origin of the cells in question when this determination can be made, and (3) the value of defining morphologic criteria for such a diagnosis. The debate over terminology, as well as morphologic criteria, is ongoing, and the readership is invited to communicate opinions to Acta Cytologica. Management of women with equivocal diagnoses varies widely from locale to locale and may differ based on how the equivocal diagnosis is qualified. Findings insufficient for the diagnosis of a high grade lesion may warrant more aggressive follow-up than cases equivocal for a low grade lesion. Where sensitivity of detection of lesions is of paramount importance, follow-up will generally consist of more frequent cytology screening or colposcopy and biopsy. However, in some countries it is considered unethical to have a high percentage of false positive diagnoses, which result in overtreatment and an unnecessary burden for women participating in cervical screening. Future studies may provide a morphologic, or perhaps molecular, basis for distinguishing true precursors of neoplasia from minor lesions of no significant clinical import; this would allow a more coherent and rational approach to diagnosis and management of women with equivocal cytologic findings.en_US
dc.languageengen_US
dc.publisherScience Printers and Publishers, Inc. The Journal's web site is located at http://www.acta-cytol.comen_US
dc.relation.ispartofActa Cytologicaen_US
dc.subject.meshAdenocarcinoma - Diagnosis - Pathologyen_US
dc.subject.meshAtrophyen_US
dc.subject.meshCell Nucleus - Ultrastructureen_US
dc.subject.meshCervical Intraepithelial Neoplasia - Diagnosis - Pathologyen_US
dc.subject.meshCervix Uteri - Pathologyen_US
dc.subject.meshCytoplasm - Ultrastructureen_US
dc.subject.meshDiagnosis, Differentialen_US
dc.subject.meshEpithelial Cells - Pathologyen_US
dc.subject.meshExocrine Glands - Pathologyen_US
dc.subject.meshFemaleen_US
dc.subject.meshHumansen_US
dc.subject.meshMetaplasiaen_US
dc.subject.meshReproducibility Of Resultsen_US
dc.subject.meshTerminology As Topicen_US
dc.subject.meshUterine Cervical Dysplasia - Diagnosis - Pathology - Therapyen_US
dc.subject.meshUterine Cervical Neoplasms - Diagnosis - Pathology - Therapyen_US
dc.subject.meshVaginal Smears - Standardsen_US
dc.titleASCUS and AGUS criteria: IAC task force summaryen_US
dc.typeArticleen_US
dc.identifier.emailCollins, RJ:rcollins@hkucc.hku.hken_US
dc.identifier.authorityCollins, RJ=rp00251en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.pmid9479320-
dc.identifier.scopuseid_2-s2.0-0031933740en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0031933740&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume42en_US
dc.identifier.issue1en_US
dc.identifier.spage16en_US
dc.identifier.epage24en_US
dc.identifier.isiWOS:000072224800003-
dc.publisher.placeUnited Statesen_US

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