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In all identified cases of high-grade histologic lesions, only 5.3% (10 of 189 cases) were preceded by a Pap test diagnosis of ASC-US. This included only 2 of the 86 cases (2.3%) of CIN 3/Ca following an ASC-US Pap test (Figure 3).
Of the 103 cases in which CIN 2 was the greatest degree of dysplasia, they included the following preceding Pap test results: 8 cases (7.8%) of ASC-US, 43 cases (41.7%) of LSIL, 18 cases (17.5%) of LSIL-H, 11 cases (10.7%) of ASC-H, and 23 cases (22.3%) of HSIL (Figure 5).
Combined low grade" Pap tests (ASC-US and LSIL) preceded 51 (49.5%) of the 103 cases of CIN 2 and 14 (16.3%) of the 86 cases of CIN 3/Ca, whereas high grade" Pap tests (ASC-H, LSIL-H, HSIL, AGC, AIS, and invasive Ca) preceded 52 (50.5%) of the 103 CIN 2 cases and 72 (83.7%)of the 86 cases of CIN 3/ CA (Figure 7).
Each preceding Pap test diagnosed as ASC-US within our study had a corresponding, positive, HR HPV (10 of 10; 100%).
Our results show a smaller proportion of histologically confirmed, high-grade lesions preceded by an ASC-US Pap test, relative to previous studies, under current practice conditions.
In particular, our study highlights the benefits of an ASC-H diagnosis (first introduced in Bethesda 2001), many cases of which would have previously fallen into the ASC-US category by default.