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Underrecognized Patterns of High-Grade Squamous Intraepithelial Lesion on ThinPrep Preparations
Abha Goyal1, Jonas J Heymann1, Susan A Alperstein1
1Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA.
American Journal of Clinical Pathology
|February 25, 2021
Summary
This study identified three key patterns in Papanicolaou (Pap) tests that can indicate high-grade squamous intraepithelial lesions (HSIL) despite initial negative results, improving human papillomavirus (HPV) test interpretation.
Area of Science:
- Cervical cytology and pathology
- Human papillomavirus (HPV) screening
- Cytopathology diagnostic patterns
Background:
- Human papillomavirus (HPV) testing is crucial for cervical cancer screening.
- Interpreting Papanicolaou (Pap) tests, especially in HPV-positive but initially negative cases, presents diagnostic challenges.
- Identifying subtle patterns of high-grade squamous intraepithelial lesions (HSIL) is essential for timely intervention.
Purpose of the Study:
- To identify less obvious patterns of HSIL in HPV-positive, Papanicolaou (Pap) test-negative cases.
- To improve the detection of HSIL in ThinPrep cervical cytology preparations.
- To analyze discrepancies in interpretation and identify key cytologic findings associated with HSIL.
Main Methods:
- Retrospective review of ThinPrep slides from HPV-positive Pap tests with subsequent HSIL histology.
- Comparison with HPV-negative Pap tests showing negative follow-up.
- Independent review by cytopathologists and consensus review with the ThinPrep Imaging System (TIS).
Main Results:
- Of 57 HPV-positive cases with subsequent HSIL, 17 (29.8%) were initially classified as negative or unsatisfactory.
- Four cases had rare abnormal cells missed by the TIS.
- Screening or interpretative errors occurred in 63.1% of cases, with atypical metaplastic cells, atypical repair, and rare syncytial groups being key findings.
Conclusions:
- Atypical metaplastic cells represent an underrecognized pattern of HSIL in cervical cytology.
- Atypical repair is another critical, often overlooked, cytologic finding indicative of HSIL.
- Rare syncytial groups are a third significant pattern associated with HSIL that requires careful identification.
