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Morphological differentiation of hyperchromatic crowded groups (HCG) in cervical cytology. Possible clinical
Julio César Villarreal Ramírez1, Jesús E Guaithero Rivas2, Lorena Ramírez3
1School of Bioanalysis, Faculty of Pharmacy and Bioanalysis, University of Los Andes, Mérida, Venezuela.
Insights
Hyperchromatic crowded groups (HCGs) in cervical cytology are key indicators, found in both normal and abnormal samples. Careful analysis of HCG morphology is crucial for accurate classification and clinical interpretation of cervical lesions.
Area of Science:
- Cytopathology
- Cervical Cancer Screening
- Histopathology
Background:
- Hyperchromatic crowded groups (HCGs) are hyperchromatic cellular aggregates found in cervical cytology.
- They appear in both negative and abnormal samples during screening for cancer and premalignant lesions.
Purpose of the Study:
- To characterize the cytomorphological features of HCG groups in cervical cytology.
- To classify HCG groups as benign/reactive, atypical, or potentially neoplastic.
- To explore the clinical significance of HCG groups in cervical cytology.
Main Methods:
- Selection of conventional cervical cytology samples that were satisfactory for analysis and exhibited HCG groups.
- Analysis of 70 cases meeting inclusion criteria from 2810 total cases.
- Morphological characterization and classification of HCG groups.
Main Results:
- HCG groups were identified in 70 (2.49%) of the 2810 cases.
- HCGs were present in 41% of negative and 59% of abnormal cytology samples.
- Atypical HCG groups (ASC-H) were most common (24.28%), followed by potentially neoplastic/HSIL (17.14%).
Conclusions:
- The variable morphology of HCG groups necessitates careful recognition and interpretation, especially in abnormal cases.
- HCGs composed of squamous metaplastic or glandular cells may indicate intracanal HSIL, requiring histopathological confirmation.
- Comprehensive assessment of cellular and background features, along with clinical information, is essential for accurate HCG classification and interpretation.
Abstract:
HCG groups (hyperchromatic crowded groups) are hyperchromatic cellular aggregates observed during routine screening for cancer and premalignant intraepithelial lesions in both negative and abnormal cervical cytology samples. This study aimed to characterise the cytomorphological features of HCG groups in cervical cytology samples, in order to classify them as benign/reactive, atypical, or potentially neoplastic, and to explore their clinical significance in this setting. Conventional cervical cytology samples that were satisfactory for analysis and exhibited HCG groups were selected. Of 2810 cytological cases, 70 (2.49%) met the inclusion criteria. HCG groups were identified in 41% of negative cytology samples and in 59% of abnormal samples. Atypical HCG groups (ASC-H) were the most common (24.28%), followed by potentially neoplastic/HSIL (17.14%). The morphology of HCG groups is variable, necessitating carefully recognition, differentiation, and interpretation, particularly in abnormal cases requiring detailed and systematic evaluation. In cases with a clear HSIL context, the presence of HCG groups composed of squamous metaplastic cells or cells with a glandular appearance may raise suspicion of intracanal HSIL, which should be confirmed by histopathological examination. Comprehensive assessment of both cellular and background features in cytological smears helps clarify the origin of HCG groups, ensuring accurate morphological characterisation and appropriate cytological classification and clinical interpretation. Clinical and epidemiological information is essential for the accurate classification of HCG groups.
