THE IMPORTANCE OF ATYPICAL SQUAMOUS CELLS IN CERVICAL PAP SMEAR IN PATIENTS AGED 65 YEARS AND OLDER AND THEIR ASSOCIATION WITH HPV

Aim: This study aims to determine the significance of atypical squamous cells (ASC) in women 65 years of age and older, and the high-risk HPV (hrHPV) status of patients diagnosed with ASCs. Materials and methods: Data base of the Department of Pathology between February 2019 and December 2020 were screened and patients over the age of 65 who had ‘ASC of undetermined significance' (ASC-US) and 'ASC-cannot exclude high-grade squamous intraepithelial lesion' (ASC-H) diagnosis on cervical PAP smear (CPS) were identified. High risk HPV (hrHPV) positive and negative patients were also examined. Results: 164 patients (151 (89.3%) ASCUS and 13 (7.7%) ASC-H) were included in the study. Follow-up information of 95 cases showed 16.8% low grade squamous intraepithleial lesion (LSIL), 5.3% high grade squamous intraepithleial lesion (HSIL), 1.1% endocervical adenocarcinoma following ASC diagnosis. 19.6% patients were hrHPV positive. In the follow-up of HrHPV positive patients, 38.9% LSIL, 22.2% HSIL, 5.6% cervical adenocarcinoma developed. Intraepithelial lesions (LSIL + HSIL) and high-grade cervical lesions (HSIL + invasive cervical carcinoma) were more common in hrHPV positive ASC-US cases compared to hrHPV negative ASC-US cases. Patients with ASC-H were more likely to have LSIL and intraepithelial lesions at follow-up compared to patients with ASC-US. Conclusion: In patients aged 65 years and older, hrHPV positive ASC cases carry a high risk for LSIL, HSIL and high grade cervical lesions. Further studies on absolute referral to hrHPV test screening in these patients would significantly contribute to the management of these patients.