ASCUS in Atrophy
Authors:
J. Dušková 1,2,3; J. Drozenová 1
; R. Hajná 1
Authors place of work:
Ústav patologie 1. LF UK a VFN
1; Katedra patologie IPVZ a
2; Vysoká škola zdravotní, Praha
3
Published in the journal:
Čes.-slov. Patol., 44, 2008, No. 1, p. 9-14
Category:
Original Article
Summary
Aim:
The peak of incidence in cervical carcinoma precedes epithelial atrophy following menopause. Nevertheless, some carcinomas develop in the postmenopausal period.
Atrophy, namely the partially developed, shares some cytomorphology features with SIL, especially if inflammatory changes, common in this period, interfere. Proliferation test is recognized and accepted as a tool to clear uncertain findings. However, it means a repetitive investigation. The study is focused on the possibility to reduce the proliferation test employment with the help of proliferation activity investigation on questionable cell groups.
Material of the retrospective study comprised routine pap smears from 22 patients. Twenty- one of them were perimenopausal and menopausal patients who had 16 inconclusive results (ASCUS or ASC-US, ASC-H in one of both versions of Bethesda classifications, i.e. ASCUS in atrophy of any type), 4 SIL in atrophy followed by histology, and 1 atrophy with negative cytology finding. In addition, there was one case of H SIL in a younger patient without atrophy. Altogether, 60 cytology findings were reviewed as many of the patients had repetitive cytologies.
Method:
As a minimum, three images with diagnostically important cell groups were archived in the LUCIA Net image archiving system (Laboratory Imaging, Prague). Subsequently, the smears were dismounted, destained and used for immunocytochemical reaction to test proliferation activity with the Ki-67 (MIB 1) antibody. The results were archived in the LUCIA Net system again. The evaluation of findings was done on a four-grade scale:
1) negative; 2) isolated positivities; 3) scattered positivities (less than 1/3 of cells in a cluster); 4) heavy disperse positivities (more than 1/3 of cells in a cluster).
Results:
The procedure provided mostly a readable result. Archiving prior and following the immunocytochemistry procedure provided possibility of comparison of the polychrome stained smears and the MIB l tested. Patients with proven SIL exhibited the positivities in groups 2) to 4) (4/5). Rare scattered positivities /group 3/ were mostly (6x) found in compact groups with the appearance of immature metaplasia. The cytopathology findings eventually normalized in these patients. In patients with isolated MIB 1 positivities /group 2/ frequently (4/7) eventually normalized as well. Nevertheless, such minimal positivities were found also in two patients with a subsequently proven CIN. The MIB 1 positivities were variable even in the histopathology sections. The cytology features of the suspicious cell groups in slides obscured by inflammation were better visible following destaining for immunocytochemistry.
Based on the results of our study we have developed an algorithm for employment of the proliferation activity test in the doubtful atrophy smears. We believe that it can be useful in the ASC-H in atrophy finding. Provided the positivities found are strong, a biopsy will be indicated. Medium and week positivities represent candidates for E-test and a 6 months control.
Key words:
cervical cytology – PAP test – atrophy – ASCUS – ASC-H in atrophy – estrogen test – proliferation activity – Ki-67 MIB1 positivity
Zdroje
1. Abati, A., Fetsch, P., Filie, A.: If cells could talk. The application of new techniques to cytopathology. Clin. Lab. Med. 1998 Sep;18: 561-583.
2. Abati, A., Jaffurs, W., Wilder, A.M.: Squamous atypia in the atrophic cervical vaginal smear: a new look at an old problem. Cancer, 1998 Aug 25;84: 200-201.
3. Abdulla, M., Hombal, S., Kanbour, A. et al.: Characterizing „blue blobs“. Immunohistochemical staining and ultrastructural study. Acta Cytol. 2000 Jul-Aug;44: 547-550.
4. Acs, G., Gupta, P.K., Baloch, Z.W.: Glandular and squamous atypia and intraepithelial lesions in atrophic cervicovaginal smears. One institution‘s experience. Acta Cytol. 2000 Jul-Aug;44: 611-617.
5. Batrinos, M., Eustratiades, M.: The diagnostic significance of parabasal cells. I. Correlation with the clinical diagnosis in 209 patients. Acta Cytol. 1975 Mar-Apr;19: 97-99.
6. Bibbo, M.: Comprehensive Cytopatology. WB Saunders, Philadelphia, 1991. 1101 stran, ss. 153-160.
7. Boon, M.E., Vinkestein, A., van Binsbergen-Ingelse, A., van Haaften, C.: Significance of MiB-1 staining in smears with atypical glandular cells. Diagn. Cytopathol. 2004 Aug;31: 77-82.
8. Bulten, J., de Wilde, P.C., Boonstra, H., Gemmink, J.H., Hanselaar, A.G.: Proliferation in „atypical“ atrophic pap smears. Gynecol. Oncol. 2000 Nov;79: 225-229.
9. Cenci, M., Vecchione, A.: Atypical squamous and glandular cells of undetermined significance (ASCUS and AGUS) of the uterine cervix. Anticancer Res. 2000 Sep-Oct;20(5C): 3701-3707.
10. DeMay, R.M.: The PAP test. ASCP Press, Chicago 2005, ss. 66-69.
11. Ejersbo, D., Jensen, H.A., Holund, B.: Efficacy of Ki-67 antigen staining in Papanicolaou (Pap) smears in post-menopausal women with atypia-an audit. Cytopathology. 1999 Dec;10: 369-374.
12. Kaminski, P.F., Stevens, C.W. Jr., Wheelock, J.B.: Squamous atypia on cytology. The influence of age. J. Reprod. Med. 1989 Sep; 34(9):617-620.
13. Kashimura, M., Baba, S., Nakamura, S., Matsukuma, K., Kamura, T.: Short-term estrogen test for cytodiagnosis in postmenopausal women. Diagn. Cytopathol. 1987 Sep;3: 181-184.
14. Keating, J.T., Wang, H.H.: Significance of a diagnosis of atypical squamous cells of undetermined significance for Papanicolaou smears in perimenopausal and postmenopausal women. Cancer, 2001 Apr 25;93: 100-105.
15. Keebler, C.M., Wied, G.L.: The estrogen test: an aid in differential cytodiagnosis. Acta Cytol. 1974 Nov-Dec;18: 482-493.
16. Kir, G., Cetiner, H., Gurbuz, A., Karateke, A.: Reporting of „LSIL with ASC-H“ on cervicovaginal smears: is it a valid category to predict cases with HSIL follow-up? Eur. J. Gynaecol. Oncol. 2004;25: 462-464.
17. Koss, L.G.: Diagnostic cytology and its histopathological bases. 4th ed. J.B. Lippincott, Philadelphia, 1992, 1657 stran, ss. 276-313
18. Pinto, A.P., Tuon, F.F., Tizzot, E.L., Torres, L.F., Collaco, L.M.: Nonneoplastic findings in loop electrical excision procedure specimens from patients with persistent atypical squamous cells of uncertain significance in two consecutive pap smears. Diagn. Cytopathol. 2002 Aug;27: 123-127.
19. Pitman, M.B., Cibas, E.S., Powers, C.N., Renshaw, A.A., Frable, W.J.: Reducing or eliminating use of the category of atypical squamous cells of undetermined significance decreases the diagnostic accuracy of the Papanicolaou smear. Cancer. 2002 Jun 25;96: 125-127.
20. Saminathan, T., Lahoti, C., Kannan, V., Kline, T.S.: Postmenopausal squamous-cell atypias: a diagnostic challenge. Diagn. Cytopathol. 1994;11: 226-230.
21. Selvaggi, S.M.: Reporting of atypical squamous cells cannot exclude a high-grade squamous intraepithelial lesion (ASC-H) on cervical samples: is it significant? Diagn. Cytopathol. 2003 Jul;29: 38-41.
22. Smedts, H.: Efficacy of Ki-67 antigen staining in Papanicolaou (pap) smears in postmenopausal women with atypia-an audit. Cytopathology, 2001 Apr;12: 130-132.
23. Solomon, D., Frable, W.J., Vooijs, G.P. et al.: ASCUS and AGUS criteria. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial. Acta Cytol. 1998 Jan-Feb;42: 16-24.
24. Thomas, A., Correa, M.M., Kumar, K.R.: Clinical profile and cervical cytomorphology in symptomatic postmenopausal women. Indian J. Pathol. Microbiol. 2003 Apr;46: 176-179.
25. Valente, P.T., Schantz, H.D., Trabal, J.F.: Cytologic changes in cervical smears associated with prolonged use of depot-medroxyprogesterone acetate. Cancer, 1998 Dec 25;84: 328-333.
26. Wied, G.L., Bibbo, M., Keebler, C.M., Koss, L.G., Patten, S.F., Rosenthal, D.: Compendium on diagnostic cytology. 8th ed., Chicago, Illinois, USA, 1997, 420 stran, ss. 117-118.
Štítky
Anatomical pathology Forensic medical examiner ToxicologyČlánok vyšiel v časopise
Czecho-Slovak Pathology
2008 Číslo 1
Najčítanejšie v tomto čísle
- ASCUS in Atrophy
- Primary Synovial Sarcoma of the Kidney
- Current Concepts and Morphological Aspects of Drug Induced Liver Injury
- Histopathological Diagnosis of Celiac Disease in Adults with Functional Dyspeptic Syndrome