Objectives: To report the prevalence of atypical squamous cells of undetermined significance and atypicalsquamous cells-cannot exclude high squamous intraepithelial lesions and to determine the possible association ofPap test results with high-risk human papillomavirus and high squamous intraepithelial lesions in women fromDuhok, Iraq. Design: A prospective, observational study was conducted between January 2005 and December2011. Overall, 596 women with a cervicovaginal Pap test showing atypical squamous cells of undeterminedsignificance and 93 atypical squamous cells-cannot exclude high squamous intraepithelial lesion for whompathologic follow-up was available were studied. Follow-up consisted of repeat cytology, colposcopy and histology.High risk human papillomavirus DNA testing was performed on exfoliated cervical cells from 106 women, usingconventional PCR after at least 36 months from the initial Pap smear. Results: Significantly high proportions ofboth atypical squamous cells of undetermined significance (87.9%) and atypical squamous cells-cannot excludehigh squamous intraepithelial lesion (62.4%) demonstrated no significant lesion on subsequent follow up. Lowsquamous intraepithelial lesions were observed in 1.7% of cases of atypical squamous cells of undeterminedsignificance and in 5.4% of atypical squamous cells-cannot exclude high squamous intraepithelial lesion. Highsquamous intraepithelial lesion was demonstrated in 0.8% and 16.1% respectively. In the latter there was alsoone case of invasive carcinoma. High-risk HPV DNA was demonstrated in 40% of atypical squamous cells ofundetermined significance and 57.1% of atypical squamous cells-cannot exclude high squamous intraepitheliallesions. Conclusions: Since both atypical squamous cells of undetermined significance and atypical squamouscells-cannot exclude high squamous intraepithelial lesion identify patients who are at an increased risk for thedevelopment of high squamous intraepithelial lesions and a considerable percentage harbor high risk-HPV,both should be retained as diagnostic categories and patients warrant a diligent follow up and testing for highrisk-HPV DNA. Colposcopic evaluation and biopsy, when indicated, are a must.
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