Good squames, bad squames

Clinical history: 68-year-old woman with a cervicovaginal smear. No previous history at this institution. Her physician reports that a smear 3 months ago was diagnosed as ASCUS (atypical squamous cells of undetermined significance). A followup biopsy showed no pathologic abnormalities.

Selected 200X images from her current Pap smear are shown.

Based on these images, what is your best course of action?


A)  Report the case as atrophy, with interpretation limited by air-drying artifact.

B) Sign it out as high-grade squamous dysplasia.

C)  Make a diagnosis of ASCUS, with a recommendation for an estrogen test.

D)  Categorize the smear as atypical glandular cells of undetermined significance (AGUS).

E. Turf the case to a colleague and go on vacation.


                                                                                        Solution