Atypical Squamous Cells: Cytopathological Findings and Correlation with HPV Genotype and Histopathology

Abstract

Objective: We aimed to assess potential associations between atypical squamous cell (ASC) subgroups: ASC-US (undetermined significance) and ASC-H (cannot exclude high-grade squamous intraepithelial lesion), regarding cytomorphological features, high-risk (HR) human papillomavirus (HPV) testing, and histological outcomes in a sample of Brazilian women. Study Design: Cross-sectional study which evaluated 1,346 liquid-based cytologies between January 2010 and July 2016 with ASC results. ASC-US and ASC-H were analyzed for frequency, diagnostic criteria, and cytological findings and compared with HR-HPV tests and histological outcomes. Results: Enlarged nucleus was the most frequent ASC-US criterion, but alternative criteria were present in 20% of the total cases. No ASC-US criteria were associated with histological outcomes or HR-HPV positivity. Parakeratosis, corneal pearl, giant cells, and binucleation were strongly associated with ASC-US while hyperkeratosis was associated with high-grade squamous intraepithelial lesions (HSIL) or a superior outcome. HR-HPV was positive in 64.39% of ASC-US and 65.38% of ASC-H. HSIL or superior outcomes also occurred in 13.33% of ASC-US and 64.71% of ASC-H cases. Conclusion: Alternative criteria for ASC-US were relatively frequent. Reactive cellular changes suggestive of atypias were more abundant in ASC-US. Although ASC-H is associated with worse histological outcomes, no differences in HPV positivity were found in comparison to ASC-US.

High-risk Human Papillomavirus Testing for Triage of Women with Previous Cytological Abnormalities from the Vale do Ribeira Region

“…29 Our study detected hrHPV in 43.5% of the ASC-H, and the prevalence of CIN 2 was 18.3%. A Brazilian study with women assisted at private clinics reported positivity for hrHPV testing in 67.7% (40/68) and 50% (17/34) prevalence of CIN2 in women with ASC-H. 30 Although the hrHPV test may assist in the differentiation between benign conditions and pre-neoplastic lesions, false-negative for CIN 2 may also occur. In the present study, HC2 was positive in 81.8% of the ASC-H with histopathological CIN 2.…”

Identification of Malignancy in PAP Smear Samples Using the CGB3 and NOP56 Genes as Methylation Markers

“…A subsequent analysis was performed to validate the CGB3 and NOP56 methylation levels in different HPV types, which were categorized as HPV16, HPV18, combined HPV (HPV16/18), 'HPV others and no HPV. HPV infection in patients with abnormal cytology is an underlying cause of cervical cancer, which accounts for 28.8 61.3% of the reported cases (Çilingir et al, 2013;de Oliveira et al, 2018;Oranratanaphan et al, 2020). At present and in the future, the result of HPV genotyping being positive for HPV strains 16 and/or 18 indicates a high risk of cervical neoplasia, with either a high or low grade of squamous cells (Huh et al 2015;de Oliveira et al, 2018;Einstein et al, 2011).…”

“…HPV infection in patients with abnormal cytology is an underlying cause of cervical cancer, which accounts for 28.8 61.3% of the reported cases (Çilingir et al, 2013;de Oliveira et al, 2018;Oranratanaphan et al, 2020). At present and in the future, the result of HPV genotyping being positive for HPV strains 16 and/or 18 indicates a high risk of cervical neoplasia, with either a high or low grade of squamous cells (Huh et al 2015;de Oliveira et al, 2018;Einstein et al, 2011). Based on previously published data (Gultekin et al, 2018;Dursun et al, 2009;Stany et al, 2006), HPV type 16 accounts for approximately 60% of all cervical cancers as compared with HPV18 and the other HR HPV types, which are responsible for 15% and 35% of all cervical cancers, respectively.…”

Cervical Neoplasia: Papillomavirus Infection and Resistance to Anti Tumor Immunity

“…Binucleated cells in intraepithelial neoplasia of the cervix show overexpression of the cell cycle bound p16 marker [89]. By analyzing the atypical epithelial cells induced by the different genotypes of human papillomavirus, the authors state that the binucleated cells are characterized by an expression of P16 [90]. While performing immunocytochemistry on the exfoliative cytology of several organs, including those of the female genital tract, the authors find that binuclear cells are labeled with PD-L1 [91].…”