Postmenopausal Squamous Atypia: Cytologic Features, Hybrid Capture 2 Tests and Contribution to the ASCUS Pool

Abstract

Objective: Postmenopausal squamous atypia (PSA) mimics squamous intraepithelial lesion (SIL). We investigate the PSA contribution to the atypical squamous cells of undetermined significance (ASCUS) pool, its cytologic features and Hybrid Capture 2 (HC2) relative light unit/cutoff (RLU/CO) values. Study Design: 658 ASCUS Pap tests in women ≥55 years were reviewed to select those with koilocyte-like cells and/or atypical parakeratosis. Follow-up was positive when a biopsy showed SIL or carcinoma or a later HC2 test was positive. Results: Sixty-nine cases (10.5%) were selected. Forty-two (60.9%) were HC2 negative, and 27 (39.1%) were HC2 positive. Follow-up was available for 23 (54.7%) HC2-negative and 19 (70.3%) HC2-positive cases. No HC2-negative (0%) and 8 HC2-positive (42.1%) cases were positive on follow-up. Within cases negative on follow-up, 3 were PSA on biopsy. PSA was characterized by perinuclear halos, mild nuclear enlargement, smooth nuclear contours, and smooth chromatin. PSA-associated RLU/CO values were 0.25–2.95. Cases with SIL or carcinoma had RLU/CO values from 3.78 to 1,241.59. Conclusions: PSA contributes 0.5–2.3% to the ASCUS pool in women ≥55 years old. HC2 testing with RLU/CO of ≥1 may result in PSA occasionally testing positive. A different cutoff is not recommended but awareness of this caveat is important.

Trouble-makers in cytologic interpretation of the uterine cervix

“…In a study by Acs et al [ 1 ], unequivocal cytologic features of those diagnosed in cytology as atypical squamous cells and later histologically confirmed as squamous intraepithelial lesion (SIL) were atypical parakeratotic/dyskeratotic cells showing irregular and hyperchromatic nuclei, orangeophilic cytoplasm with anisocytosis, and increased N:C ratio. Pseudokoilocytosis characterized by perinuclear halo with slightly increased size of nuclei can also be seen in atrophic smear and mislead to an overdiagnosis of LSIL, however, the nuclear enlargement is mild (1.5–2.5 intermediate cell nuclei), nuclear contours are mostly smooth, and chromatin pattern is evenly distributed and smooth [ 7 ]. Nuclear hyperchromasia and irregular nuclear contours are the most reliable cytomorphological criteria [ 8 , 9 ].…”

A Practical Approach to Squamous Abnormalities on Cervical Cytology: Overview of Interpretive Criteria and Guidance for Altering Thresholds in Response to Quality Assurance Findings

“…Overinterpretation of atrophic changes is another major problem that may lead to an excess frequency of ASC-US [26,27]. The presence of an exclusively immature population of cells makes application of the usual criteria somewhat more difficult (shown in Fig.…”