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Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion: diagnostic features in surepath™

Nalini Gupta1, John Crossley, Nick Dudding

  • 1Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. nalini203@gmail.com

Diagnostic Cytopathology
|July 19, 2012
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This study identified key cytological features in SurePath™ cervical samples diagnosed as atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H). Nuclear crowding, disorganization, and steep edges are crucial indicators of high-grade disease.

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Area of Science:

  • Cervical Cytopathology
  • Gynecologic Oncology
  • Histopathology

Background:

  • Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) is a critical cytologic diagnosis requiring careful evaluation.
  • Identifying reliable predictors of high-grade disease in ASC-H cases is essential for appropriate patient management.

Purpose of the Study:

  • To determine the circumstances of ASC-H diagnoses in SurePath™ cervical samples.
  • To identify specific cytological criteria that predict high-grade squamous intraepithelial lesions (HSIL) in ASC-H cases.

Main Methods:

  • Retrieved 2,335 SurePath™ samples diagnosed as ASC over two years, including 1,112 with hrHPV status.
  • Reviewed 88 ASC-H cases based on follow-up histology and hrHPV status, categorizing them into CIN2+ (Category A) or ≤CIN1/hrHPV negative (Category B).
  • Analyzed cytological features such as high-grade clusters (HCGs), dispersed metaplastic cells, and scattered small atypical cells.

Main Results:

  • Of 105 ASC-H cases, 50.3% had CIN2+ lesions; 78% were hrHPV positive.
  • High-grade clusters (HCGs) were present in 56.3% of Category A and 75% of Category B cases.
  • Nuclear crowding, disorganization, and steep edges in HCGs predicted high-grade disease; disproportionate nuclear:cytoplasmic ratio and irregular chromatin were key in dispersed atypical cells.

Conclusions:

  • The majority of ASC-H diagnoses contain HCGs, with specific morphologic features indicating higher risk.
  • Nuclear features like crowding, disorganization, and steep edges in HCGs are strong predictors of CIN2+.
  • In cases with dispersed atypical cells, a high nuclear:cytoplasmic ratio and irregular chromatin are vital for predicting high-grade disease.