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Can Mitotic Figures in Hyperchromatic Crowded Groups be Cytodiagnostic Criteria for High-Grade Squamous
Hisae Suzuki1, Yumeno Kondo2, Chihiro Oda2
1Department of Pathology, Nara Medical University Hospital, Nara, Japan.
Insights
Detecting two or more mitoses in hyperchromatic crowded groups (HCGs) of cervical cytology suggests high-grade squamous intra-epithelial lesions (HSIL). PHH3-ICC analysis offers a more sensitive method for mitotic figure detection in HSIL diagnosis.
Area of Science:
- Cytopathology
- Oncology
- Histology
Background:
- Cervical cancer screening relies on cytological evaluation of cervical specimens.
- Distinguishing high-grade squamous intra-epithelial lesions (HSIL) from low-grade lesions is crucial for patient management.
- The presence of mitotic figures in specific cellular groups is being investigated as a potential diagnostic marker.
Purpose of the Study:
- To determine if mitoses within hyperchromatic crowded groups (HCGs) in cervical cytology can be a criterion for diagnosing HSIL.
- To compare the efficacy of different staining methods (Pap, HE, PHH3-ICC, PHH3-IHC) in identifying mitotic figures associated with HSIL.
Main Methods:
- Analysis of mitotic figures per high power field (HPF) in Pap, hematoxylin eosin (HE), PHH3-immunocytochemical (ICC), and PHH3-immunohistochemical (IHC) stained cervical samples.
- Quantification of mitotic figures within HCGs and across different epithelial layers.
- Statistical comparison of mitotic figure frequencies between HSIL and low-grade squamous intra-epithelial lesions (LSIL) groups.
Main Results:
- Significantly higher numbers of mitotic figures were observed in HCGs of HSIL compared to other groups across Pap and PHH3-ICC samples (P < 0.001).
- The frequency of two or more mitoses was significantly higher in HSIL (Pap: P = 0.002, PHH3-ICC: P < 0.001) than in LSIL.
- PHH3-ICC showed a significantly higher frequency of two or more mitoses in HSIL compared to Pap samples (P = 0.042). HE and PHH3-IHC also revealed significantly higher mitotic counts in the middle/upper layers of HSIL compared to LSIL (P = 0.0089 and P = 0.0002, respectively).
Conclusions:
- The presence of two or more mitotic figures per HPF in HCGs of cervical cytology is indicative of potential HSIL.
- PHH3-ICC is a more sensitive and easily observable method for detecting mitoses, serving as a valuable marker for HSIL.
- Mitotic activity in specific cellular compartments can aid in the cytological diagnosis of HSIL.
Aims:
The present study aimed to investigate whether the presence of mitoses in hyperchromatic crowded groups (HCGs) in cervical cytological specimens can serve as cytological criteria for high-grade squamous intra-epithelial lesions (HSILs).
Methods And Material:
Various parameters were examined, including the frequency of mitotic figures per high power field (HPF) in Pap, hematoxylin eosin (HE) samples, and PHH3 immunocytochemical (ICC) and immunohistochemical (IHC) analyses.
Results:
In the Pap and PHH3-ICC samples, the number of mitotic figures observed in HCGs was significantly higher in HSIL (P < 0.001) compared to other groups. Furthermore, the frequency of observing two or more mitoses was significantly higher in HSIL (Pap: P = 0.002, PHH3-ICC: P < 0.001) than in low-grade squamous intra-epithelial lesions (LSILs). Moreover, a comparison between Pap samples and PHH3-ICC showed that the frequency of two or more mitoses was significantly higher in the PHH3-ICC analysis of HSIL (P = 0.042). Regarding HE and PHH3-IHC samples, counting the number of mitoses in the lower and middle/upper layers of the squamous epithelial layer revealed that HSIL had a significantly higher value (HE: P = 0.0089, PHH3-IHC: P = 0.0002) than LSIL in the middle/upper layers.
Conclusions:
Hence, the presence of two or more mitotic figures in HCGs per HPF in cervical cytology indicates a suspicion of HSIL. The detection of mitoses in PHH3-ICC samples is more sensitive and easier to observe than in Pap samples, making it a valuable mitotic marker.
