Nuclear alterations of cells and atypical metaplas:ic cells in cervical smears are predictive criteria of high-grade cervical intraepithelial neoplasia

Diagnoses based on the screening of cervical smears show low interobserver reproducibility and are frequently discordant with the final histological diagnosis. The aim of this study was to identify which of the cytomorphologic criteria used in the screening of cervical smears were most predictive of the histopathological grades of cervical intraepithelial neoplasia. The abnormal cervical smears of 206 women were reviewed blindly according to 22 pre-established cytomorphological criteria. Colposcopic evaluation was carried out in all cases. The marked presence of several nuclear criteria frequently found together in the same smear was associated with high grade intraepithelial neoplasia regardless of the presence of any other criteria. On the other hand, when the nuclear criteria were less evident, the cluster of criteria related to metaplastic cells was predictive of a diagnosis of high-grade intraepithelial neoplasia. Focusing on selected cytological criteria can aggregate predictive value to cervical smear diagnoses.

Cervical smear; Metaplastic cells; Predictive value; Screening; Cervical cancer

[1] Kruse A.J., Skaland I., Janssen E. A. et al.: "Quantitative molecular parameters to identify low-risk and high-risk early CIN lesions Role of markers of proliferative activity and differentiation and Rb availability". Int. J. Gynecol. Pathol., 2004, 23, 100.

[2] National Cancer Institute Workshop: "The Bethesda System 2001". (Consulted on October 13, 200 I). Available on the internet http://www.bethesda2OOl cancer.gov/.

[3] Grenko R.T., Abendroth C.S., Frauenhoffer E.E., Ruggiero F.M., Zaino R.J.: "Variance in the interpretation of cervical biopsy specimens obtained for atypical squamous cells of undetermined significance". Am. J. Clin. Pathol., 2000,114, 735.

[4] Stoler M.H., Shiffman M.: "Tnterobserver reproducibility of cervical cytologic and histologic interpretations. Realistic estimates from the ASCUS-LSIL Triage Study". JAMA, 2001, 285, 1500.

[5] Sherman E.M., Solomon D., Shiffman M.: "A comparison of equivocal LSIL and equivocal HSIL cervical cytology in the ASCUS LSIL Triage study". Am. J. Clin. Pathol., 2001, 116, 386.

[6] Barres D., Bergeron C.: "Reproducibility of cytologic diagnosis: study of CRTSAP lie-de-France". Gynecol. Obstet. Fertil., 2000, 28, 120.

[7] Juskevicius R., Zou H.K., Cibas S.E.: "An analysis of factors that influence the ASCUS/SIL ratio of pathologists". Am. J. Clin. Pathol., 2001, 116, 331.

[8] Kass G.V.: "An exploratory technique for investigating large quantities for categorical data". Appl. Statist., 1980, 29, 119.

[9] Sheils L. A., Wilbur D.C.: "Atypical squamous cells of undetermined significance: Stratification of the risk of association with, or progression to, squamous intraepithelial lesions based on rnorphologic subcategorization". Acta Cytol., 1997, 41, 1065.

[10] Nasser S.M., Cibas E.S., Crum C.P., Faquin W.C.: "The significance of the Papanicolaou smear diagnosis of low-grade squamous intraepithelial lesion cannot exclude high-grade squamous intraepithelial lesion". Cancer, 2003, 99, 272.

[11] Sherman E.M., Solomon D., Shiffman M.: "A comparison of equivocal LSIL and equivocal HSIL cervical cytology in the ASCUS LSIL Triage study". Am. J. Clin. Pathol. 2001, 116, 386.

[12] McKee T.G.: "Citopatologia". Trad. Nilson de Martello. Artes medicas Ltda, Sao Paulo, 1997, 52.

[13] Quddus R.M., Sung J.C., Steinhoff M.M. et al.: "Atypical squamous metaplastic cells". Cancer, 2001, 93, 16.

[14] Sprenger E., Schwarszmann P., Kirkpatrick M. et al.:'The false negative rate in cervical cytology. Comparison of monolayers to conventional smears". Acta Cytol., 1996, 40, 81.

[15] Hatem F., Wilbur D.C.: "High grade squamous cervical lesion following negative Papanicolaou smears: false-negative cervical cytology or rapid progression". Diagn. Cytopathol., 1995, 12, 135.

[16] Montes A.M., Cibass E., Dinisco A.S., Lee R.K.: "Cytologic characteristics of abnormal cells in prior "normal" cervical/vaginal Papanicolaou smears from women with a high grade squamous intraepithelial lesion". Cancer Cytopathol., 1999, 87, 56.

[17] Wilbur D.C.: "False negative in focused rescreening of Papamcolaou smears: how frequently are'abnormal'cells detects in retrospective review of smears preceding cancer or high-grade intraepithelial neoplasia?". Arch. Pathol. Lab. Med., 1997, 121, 273.

[18] Sherman M.E., Tabbara S.O., Scott D.R. et al.: "ASCUS, rule out HSIL: cytologic features, histologic correlates, and human papillomavirus detection". Mod. Pathol., 1999, 12, 335.