[ASCUS in atrophy]

The peak of incidence in cervical carcinoma precedes epithelial atrophy following menopause. Nevertheless, some carcinomas develop in the postmenopausal period. Atrophy, namely the partially developed, shares some cytomorphology features with SIL, especially if inflammatory changes, common in this period, interfere. Proliferation test is recognized and accepted as a tool to clear uncertain findings. However, it means a repetitive investigation. The study is focused on the possibility to reduce the proliferation test employment with the help of proliferation activity investigation on questionable cell groups. Material of the retrospective study comprised routine pap smears from 22 patients. Twenty-one of them were perimenopausal and menopausal patients who had 16 inconclusive results (ASCUS or ASC-US, ASC-H in one of both versions of Bethesda classifications, i.e. ASCUS in atrophy of any type), 4 SIL in atrophy followed by histology, and 1 atrophy with negative cytology finding. In addition, there was one case of H SIL in a younger patient without atrophy. Altogether, 60 cytology findings were reviewed as many of the patients had repetitive cytologies.

As a minimum, three images with diagnostically important cell groups were archived in the LUCIA Net image archiving system (Laboratory Imaging, Prague). Subsequently, the smears were dismounted, destained and used for immunocytochemical reaction to test proliferation activity with the Ki-67 (MIB 1) antibody. The results were archived in the LUCIA Net system again. The evaluation of findings was done on a four-grade scale: 1) negative; 2) isolated positivities; 3) scattered positivities (less than 1/3 of cells in a cluster); 4) heavy disperse positivities (more than 1/3 of cells in a cluster).

The procedure provided mostly a readable result. Archiving prior and following the immunocytochemistry procedure provided possibility of comparison of the polychrome stained smears and the MIB I tested. Patients with proven SIL exhibited the positivities in groups 2) to 4) (4/5). Rare scattered positivities /group 3/ were mostly (6x) found in compact groups with the appearance of immature metaplasia. The cytopathology findings eventually normalized in these patients. In patients with isolated MIB 1 positivities /group 2/ frequently (4/7) eventually normalized as well. Nevertheless, such minimal positivities were found also in two patients with a subsequently proven CIN. The MIB 1 positivities were variable even in the histopathology sections. The cytology features of the suspicious cell groups in slides obscured by inflammation were better visible following destaining for immunocytochemistry. Based on the results of our study we have developed an algorithm for employment of the proliferation activity test in the doubtful atrophy smears. We believe that it can be useful in the ASC-H in atrophy finding. Provided the positivities found are strong, a biopsy will be indicated. Medium and week positivities represent candidates for E-test and a 6 months control.