Atypical squamous cells, cannot exclude high‐grade squamous intraepithelial lesion: Diagnostic features in surepath™ cervical samples

Abstract

This study was undertaken to identify the situations in which a diagnosis of "Atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion (ASC-H)" is offered in SurePath™ cervical samples and to identify cytological criteria helpful in predicting high-grade disease. 2,335 (3.4%) SurePath samples reported as atypical squamous cells (ASC) over a period of 2 years, including 1,112 cases with known hrHPV status were retrieved. 105/1,112 cases were categorized into ASC-H, and slides were available for review in 88/105 cases. These 88 samples were divided into two categories based on follow-up histological outcome and hrHPV status-category A: cases with CIN2+ lesions on follow-up (n = 48) and category B: cases with ≤CIN1 lesions or hrHPV negative status (n = 40). 78% (82/105) cases of ASC-H tested positive for hrHPV. Overall CIN2+ lesions were found in 50.3% (53/105) cases. Of 88 cases reviewed, HCGs were noted in 56.3% (27/48) cases in category A and 75% (30/40) cases in category B. Dispersed metaplastic cells and scattered small atypical cells were seen in 37.5% (18/48) cases in category A and 12.5%(5/40) in category B. The majority of cases with dispersed atypical cells had <20 cells/sample and cases with HCGs had <10 HCGs per sample. The majority of the cases reported as ASC-H contained HCGs. Of these groups with nuclear crowding, disorganization and those with steep edges ("blocks") are likely to predict high-grade disease. The samples with only dispersed atypical cells had <20 cells/sample in majority of cases. In these, a disproportionate and especially high nuclear: cytoplasmic ratio and irregular chromatin were the most useful features in predicting high-grade disease.

Clinical Relevance of ASC-H Cytologies: Experience in a Single Tertiary Hospital

“…Nevertheless, these features alone do not seem to be decisive enough to reach a definite diagnosis of a high-grade lesion. Gupta et al [6] studied ASC-H morphology in SurePath samples and showed that an increased and disproportionate nuclear/cytoplasmic ratio and an abnormal granular chromatin pattern were statistically significant factors in predicting high-grade disease. Abati et al [7] observed that nuclear hyperchromasia and irregular nuclear membranes were the criteria that more accurately predicted high-grade lesions in postmenopausal Pap tests.…”

A Comparison of Cytomorphological Features of ASC-H Cells Based on Histopathological Results Obtained from a Colposcopic Target Biopsy Immediately after Pap smear Sampling

“…However, HSIL exhibits small atypical cells, and differentiating the true high-grade squamous intraepithelial lesion (HSIL) from benign reserve cell hyperplasia, endocervical glandular cells, and other benign degenerative changes has been found to be difficult in many cases, leading to a noticeable discrepancy in diagnoses among cytotechnologists and pathologists as well as among institutions (Louro et al, 2003). Thus, to improve the accuracy of the diagnosis, considerable effort has been devoted to the analysis of the cytological features of ASC-H. Cytomorphological features of ASC-H have been analyzed in previous studies using tissue biopsy specimens taken several weeks and months after the initial diagnosis of ASC-H. (Sheil et al, 1997;Montes Hiromi Hata 1 , Kaori Okayama 2 , Junko Iijima 1 , Koji Teruya 3 , Natsuko Shiina 4 , Timothy Caniz 4 , Yasuyoshi Ishii 5 , Masahiko Fujii 5 , Mizue Oda 5 , Mitsuaki Okodo 1 * Ronnett et al, 1999;Quddus, et al, 2001;Louro et al, 2003;Selvaggi, 2003;Duncan and Jacob, 2005;Saad et al, 2006;Sherman et al, 2006;Chivukula et al, 2007;Mokhtar et al, 2008;Gupta et al, 2013a;Gupta et al, 2013b). However, it is possible that the cytomorphological features of ASC-H did not correlate with the histopathological findings in the biopsied tissue because the cells and tissue specimens were not collected simultaneously.…”