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

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.