In cervical cytology reporting using the Bethesda system, which classification has the HIGHEST sensitivity but LOWEST specificity for identifying CIN 2+?

• A ASC-US (atypical squamous cells of undetermined significance) ✓
• B HSIL (high-grade squamous intraepithelial lesion)
• C LSIL (low-grade squamous intraepithelial lesion)
• D ASC-H (atypical squamous cells — cannot exclude HSIL)

Explanation

ASC-US (atypical squamous cells of undetermined significance) is the most common abnormal cytology result and captures the broadest group, including women with genuine CIN 2+ and many with reactive changes — hence highest sensitivity but lowest specificity for CIN 2+. Only approximately 10–15% of ASC-US smears harbor CIN 2+ on histology. HSIL has high specificity (most HSIL represent true CIN 2–3) but lower sensitivity as it misses the ASC-US population. Reflex HPV testing is the standard management for ASC-US.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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