ASC-H

I may not be correct or not have enough experience in this, but the photos uploaded above are not diagnostic for LSIL to me. The associated inflammatory change further dissuades me from making a definite diagnosis of LSIL or mild dysplasia. Perhaps I am too conservative.

Dr. Yuexin's dillema is not uncommon in our daily practice. Allow me to share how I would approach it. ASC-H and HSIL (CIN-2 or moderate dysplasia) and atrophic cervicitis are diagnoses with overlapping cytologic features. If no LSIL is seen in the background, the patient's age and history can help me decide on difficult cases. For example, atrophic cervicitis are common among post-menopausal women and women who have received radiation therapy to the pelvis. Horminal effects during or immediately after a pregnancy often increase cytologic atypia, and I would be extra careful in diagnosing LSIL, ASC-H or HSIL-CIN-2 in these women. When I still have doubt, I would either recommend repeat cytologic exam in 3 months or high-risk HPV DNA test.

If the background contains cells clearly diagnostic of LSIL, the next question is how often do one finds cells suggestive of HSIL-CIN-2. If there are many such cells, they are diagnostic of HSIL-CIN-2 to me. However, if only rare or a few such cells are seen and one cannot be sure of the HSIL-CIN-2 diagnosis, I would give a comment stating that "rare cells suggestive of HSIL-CIN-2 (moderate dysplasia) are seen" and recommend colposcopic biopsy.

Surgical overtreatment (conization) for mild dysplasia is not uncommon. I have heard of lawsuits against pathologists and gynecologists filed by young women who were diagnosed of LSIL and received conization with resultant cervical incompetence, making them difficult to carry pregnancy to full-term. This is potentially an increasing problem, and we have to be aware of this ramification of our cytologic diagnosis.

abin译：也许我的观点不正确或者对此没有足够经验，但我认为上述图像不应诊断为LSIL。相关的炎性改变进一步使我不能下LSIL或轻度异型增生的明确诊断。也许我的看法太保守了。
月新医生的困惑并非少见。请允许我介绍自己的认识方式。ASC-H和HSIL (CIN-2或中度异型增生)和萎缩性宫颈炎在细胞学特征上有重叠。如果背景上没有见到LSIL，患者的年龄和病史可能会帮助我决定这些困难病例的诊断。例如，萎缩性宫颈炎常见于绝经后妇女和接受过盆腔放射治疗后。妊娠期间或妊娠初期的激素通常会增加细胞学上的不典型性，对这些妇女诊断为LSIL、ASC-H或HSIL-CIN2时我会格外小心。当我仍然有疑问时，我会建议3月内复查细胞学或检测高危型HPV-DNA。
如果背景包含明确诊断为LSIL的细胞，下一个问题就是，这些提示为HSIL-CIN2的细胞出现的频率（或数量）。如果这些细胞较多，我会诊断为HSIL-CIN-2。相反，如果这些细胞很少或者并不多见，不能确信HSIL-CIN-2的诊断，我会加上备注：“见到少数细胞提示为HSIL-CIN-2（中度异型增生）”，并建议阴道镜活检。
对轻度异型增生的过度手术治疗（锥形切除术）也不少见。我听说过年轻妇女因诊断为LSIL并接受锥形切除术导致宫颈功能不全而难以足月妊娠，引起对病理医生和妇产科医生的诉讼。这是一个潜在上升中的问题，我们必须了解这一细胞学诊断上的分岐。

有这嬷多的细胞学老师在，我真是太高兴了
对于细胞学我还只是刚入门，以后还得请各位老师多多指教。谢谢！