The Effect of Age, Race, Pregnancy and Treatment Facility on the Follow-up Biopsy Rate for Atypical Squamous Cells, Cannot Exclude High-grade Squamous Intraepithelial Lesion (ASC-H) and High-grade Squamous Intraepithelial Lesion (HSIL) Diagnoses at Two New Orleans Teaching Hospitals
changes were found in 55 cases. Interestingly, no transformation zone was found in 20 cases. We have observed that the incidence of dysplasia in patients below 40 is 64.3% vs. 53.8% (pZ0.147) in patients above 40 years. If we combine the dysplastic cases, the difference is more significant, of these 309 cases, 179 (57.9%) cases showed dysplastic changes including CIN-1, CIN-2 or CIN-3. There were 67 cases with high risk HPV DNA Testing. HPV DNA was positive in 39 of dysplastic cases [(14 CIN-1), (24 CIN-2 or CIN-3)] and negative in 5 (1 CIN-1 & 4 CIN2/3) cases; for non-dysplastic cases (benign, inflammation, koilocytic), 14 cases were HPV positive and 9 cases negative (Sensitivity 73.6%, Specificity 64.3%, PPV 88.6%, NPV 39.1%, pZ0.012). Conclusions: We concluded that cases diagnosed as ASC-H should be followed-up with caution as they are strongly associated with dysplasia (57.9%) especially CIN2/3 (38.83%,high grade dysplasia). Reflex HPV testing is an important predictor of dysplasia with 88.63% positivity in dysplastic cases. Reactive changes and koilocytic atypia can result in the reactive atypia. Sampling errors, such as lack of transformation zone and sampling of the non-representative areas are the most common factors of discrepancy between the pap smear and subsequent biopsy. Close follow-up of ASC-H cases is recommended.