ABSTRACT
BACKGROUND: Hyperchromatic crowed groups (HCGs) are defined as three-dimensional aggregates of crowded cells with hyperchromatic nuclei, and are frequently encountered in cervicovaginal liquid-based cytology (LBC). Here, we aimed to examine the prevalence of HCGs in cervicovaginal LBC and the cytomorphological characteristics of various epithelial cell clusters presenting as HCGs. METHODS: We first examined the prevalence of HCGs in a "routine cohort" of LBC cytology (n=331), consisting of all cervicovaginal LBCs accessioned over 3 days from outpatient clinics (n=179) and the screening population (n=152). Then we examined a second "high-grade epithelial cell abnormalities (H-ECA) cohort" (n=69) of LBCs diagnosed as high-grade squamous intraepithelial lesion (HSIL), squamous cell carcinoma (SCC), or adenocarcinoma during 1 year. RESULTS: HCGs was observed in 34.4% of the routine cohort and were significantly more frequent in the epithelial cell abnormality category compared to the non-neoplastic category (p=.003). The majority of HCGs represented atrophy (70%). Of the 69 histologically confirmed H-ECA cases, all contained HCGs. The majority of cases were HSIL (62%), followed by SCC (16%). Individually scattered neoplastic cells outside the HCGs were significantly more frequent in SCCs compared to glandular neoplasia (p=.002). Despite the obscuring thick nature of the HCGs, examining the edges and the different focal planes of the HCGs and the background were helpful in defining the nature of the HCGs. CONCLUSIONS: HCGs were frequently observed in cervicovaginal LBC and were mostly non-neoplastic; however, neoplastic HCGs were mostly high-grade lesions. Being aware of the cytomorphological features of different HCGs is important in order to avoid potential false-negative cytology interpretation.
ABSTRACT
BACKGROUND: Although the Papanicolaou (Pap) test is the first-line screening method for cervical cancer, it has low sensitivity for detection of human papillomavirus (HPV)-infected cervical lesion compared to the HPV test. The aims of this study are to determine novel cytomorphologic parameters for HPV infection in patients previously diagnosed as negative for intraepithelial lesion or malignancy (NILM) and to comparatively analyze the detection performance of 3 HPV tests: nested PCR, the DNA Chip test, and the Liquid Beads Microarray (LBMA) assay. METHODS: In total, 232 patients diagnosed with NILM were enrolled and assessed using 8 cytomorphologic parameters. RESULTS: Six non-classical cytomorphologic features were identified as novel characteristics suggesting HPV infection in patients initially diagnosed with NILM. A combination of these 6 variables showed the best predictive performance for HPV infection (area under the curve, 0.722). In terms of diagnostic ability, the LBMA assay showed better performance in detection of HPV infection (39.7%) in NILM cases compared to the other tests. CONCLUSIONS: Our results suggest that the novel cytomorphologic features used in this study can be used as supportive morphologic parameters to increase the sensitivity of cytological screening tests. The LBMA assay could be used as an advanced method for HPV detection.
