1. ASC-US Y L-SIL
DRA LUISA ROJAS JARAMILLO
DIPLOMADO EN COLPOSCOPIA
INSTITUTO NACIONAL DE PERINATOLOGIA
2. INTRODUCCIÓN
• ASC-US
• Atypical squamous cells (undeterminated significance)
• ASC
• Es la mas frecuente de todas las interpretaciones de citología cervical.
• En el Sistema Bethesda 2014 sigue incluyendo como anormalidad de
células escamosas epiteliales.
• ASC-US y ASC-H
Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
3. INTRODUCCIÓN
• La mayoría de ASC-US son sugestivas de LSIL (Low-Squamous
intraepithelial lesion)
• Se prefiere –significado indeterminado- aprox. 10-20% HSIL
• ASC
• 90% ASC-US
• 10% ASC-H
Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
4. ASC
• No representa una sola entidad biológica.
• Causas no relacionadas con VPH
• Inflamación
• Efecto hormonal
• Atrofia con degeneración
• Otros.
Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
5. CARACTERÍSTIC
AS – ASC
Diferenciación escamosa
Aumento en la relación
núcleo/citoplasma
Cambios mínimos
nucleares.
Hipercromasia, irregular,
aglomeración cromatina,
manchado, multinuclear
Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
6. ASC-US
• Sugestivo de LSIL
• Criterios
• Núcleo 2 ½ a 3 veces el área del núcleo de una cel. Escamosa Intermedia
normal (35µm2) el doble del tamaño del nucleo de una cel. Metaplásica.
(50µm2)
• Ligeramente elevado proporción N/C
• Minima hipercromasia, irregularidad en la distribución de la cromatina.
• Anormalidad nuclear asociado con citoplasma denso (narangeifilico)
Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
7. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
8. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
9.
10. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
11. CRITERIOS POR
PREPARACIÓN
• Citología convencional
• Las células pueden aparecer
mas planas y alargadas por
el frotis y/o artefactos por
secado al aire.
Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
12.
13. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
14. • Citología base liquida
• Las células parecen mas pequeñas, con
proporción núcleo/citoplasma mayor.
Bidimensional.
Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
15.
16. EXPLICACIÓ
N
• Las células intermedias normales están
presentes en la laminilla para proveer como
fuente de comparación para evaluar si cumple
o no con criterios para ASC-US o LSIL
• Tamaño y forma de Celulas escamosas
superficiales o intermedias.
Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
17. La prevalencia de ASC-
US declina con el
incremento de la edad
Mas frecuente en
mujeres jóvenes y con
mayor frecuencia refleja
lesión relacionada por
VPH
Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
18. RIESGO DE NEOPLASIA EN MUJERES 30-64
AÑOS CON RESULTADO ANORMAL EN
CITOLOGÍA
Citología NIC2+ NIC3+ Cáncer
Cervical
negativa 0.68% 0.26% 0.025%
ASC-US 6.9% 2.6% 0.18%
HPV+ 18% 6.8% 0.41%
HPV- 1.1% 0.43% -
Data from: Katki HA, Schiffman M, Castle PE, et al. Benchmarking CIN 3+ risk as the basis for incorporating HPV and Pap cotesting into cervical screening and
management guidelines. J Low Genit Tract Dis 2013; 17:S28.
Katki HA, Schiffman M, Castle PE, et al. Five-year risks of CIN 3+ and cervical cancer among women with HPV testing of ASC-US Pap results. J Low Genit Tract
21. L-SIL • Es la segunda anormalidad más comun en
citología cervical
https://www.uptodate.com/contents/cervical-cytology-evaluation-of-low-grade-squamous-intraepithelial-lesions-
lsil?search=lsil&source=search_result&selectedTitle=1~23&usage_type=default&display_rank=1
22. L-SIL
• Abarca displasia leve y NIC1
• Varios estudios han demostrado que los criterios morfológicos
para distinguir la “koilocitosis” de la displasia leve o CIN I
varían entre los investigadores y carecen de importancia clínica
Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
23. CRITERIOS PARA LSIL
• Células pueden ser individual, en grupos, en hojas
• Cambios citológicos se confinan en células escamosas
intermedias o superficial madura.
• Tamaño grande con citoplasma bien definido “maduro”
bastante abundante.
• Núcleo 3veces mayor al de un núcleo de una cel intermedia
normal.
Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
24. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
25. CRITERIOS PARA LSIL
• Generalmente nucleo hipercromatico.
• Anisonucleosis
• Cromatina con distribución uniforme(granulos grueso,
manchado denso, opaco)
• Contorno nucleas variable (irregular o suave)
• Bi o multinuclear
• Nucleolos ausentes o no visibles.
Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
26. • Koilocitos o cavitación perinuclear.
Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
27. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
28. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” thirs edition Ebook, 2015, Springer.
30. RIESGO DE NEOPLASIA
Citología NIC2+ NIC3+ Cáncer
Cervical
LSIL 16% 5.2% 0.16%
HPV+ 19% 6.1%
HPV- 5.1% 2.0% -
Katki HA, Schiffman M, Castle PE, et al. Five-year risks of CIN 2+ and CIN 3+ among women
with HPV-positive and HPV-negative LSIL Pap results. J Low Genit Tract Dis 2013; 17:S43.
Notas del editor
A 32-year-old woman. Atypical intermediate squamous cells
with a nucleus 2−3Å~ the area of a normal intermediate squamous cell nucleus and mild irregularity
of nuclear contour. This isolated cell has some features suggestive of HPV infection. hrHPV was
positive. Follow-up biopsy revealed LSIL (CIN1)
ASC-US ( LBP, ThinPrep ). A 28-year-old woman. An intermediate squamous cell with
an enlarged nucleus and slight nuclear membrane irregularity. The atypical features do not meet
the criteria for LSIL. hrHPV was positive. Follow-up biopsy revealed LSIL (CIN1)
ASC-US ( LBP, SurePath ). Routine screen from a 32-year-old woman. Single atypical
squamous cell with ill-defi ned cytoplasmic halo in a background of infl ammation. Adjacent squamous
cell shows adherent lactobacilli. HPV testing was not performed on this sample
ASC-US ( LBP, ThinPrep ). A 28-year-old female. An atypical binucleated intermediate
cell with molded nuclei and orangeophilic cytoplasm suggestive but not diagnostic of LSIL.
hrHPV was positive. Follow-up biopsy revealed LSIL (CIN1)
Negative for intraepithelial lesion or malignancy (NILM) versus atypical squamous
cells – undetermined signifi cance (ASC-US) ( CP ). Perimenopausal woman. Mature squamous
cells show mild nuclear enlargement, binucleation, and even chromatin distribution. Note benign
endocervical cells at bottom of fi eld
ASC-US ( CP ). Cells with multinucleation, nuclear enlargement, and air-drying artifact,
possibly representing LSIL (CIN1)
ASC-US ( LBP, SurePath ). A 21-year-old woman. Thick cohesive sheet of cells with
focal nuclear enlargement, orangeophilic cytoplasm, poorly formed cytoplasmic vacuoles, and
binucleation. Follow-up biopsy was LSIL (CIN1)
Nuclear area ( LBP , ThinPrep ). The nuclear area of an intermediate squamous cell is
approximately 35 μm 2 . This is used as a reference to measure abnormal squamous cells such as
ASC-US (approximately 100 μm 2 ) and LSIL (approximately 150–175 μm 2 )
LSIL ( LBP , ThinPrep ). A 32-year-old woman, day 15, routine cervical cytology screening.
Note the overall large cell size, “smudged” nuclear chromatin, well-defined cytoplasm, and
multinucleation
LSIL ( LBP , ThinPrep ). Routine screen from a 32-year-old woman. Nuclear abnormalities
are required to make an interpretation of LSIL. HPV cytopathic effect manifested by perinuclear
cavitation often accompanies the nuclear abnormalities but is not required for an interpretation of
LSIL
Fig.
LSIL ( LBP , SurePath ). Cells with diagnostic koilocytic features of LSIL have a sharply
defi ned perinuclear cavity, condensation of cytoplasm around the periphery, and abnormal nuclear
features including enlargement and nuclear membrane irregularity. In liquid-based samples,
nuclear hyperchromasia may be less evident