Julian Crasta

Cytology Triage for HPV‐Positive Postmenopausal Women in a Setting of Cervical Cancer Screening

ABSTRACTBackgroundGlobally, cervical cytology continues to serve as the cornerstone of cervical cancer screening programs, but WHO 2021 guidelines advocate HPV DNA testing as the primary screening modality due to its heightened sensitivity. This method necessitates additional triage with cytology or colposcopy to detect precancerous lesions. Hormonal shifts and anatomical alterations in postmenopausal women may impact diagnostic outcomes in either modality.AimTo describe the spectrum of cytological lesions in HPV‐positive postmenopausal women to detect precancerous lesions as part of cervical cancer screening.MethodsConventional cytology smears of high‐risk HPV‐positive postmenopausal women were reported according to The Bethesda System 2014. Results of follow‐up biopsies of the positive smears were recorded, and cyto‐histological correlation was performed.ResultsThe retrospective study included conventional cytology smears of 124 postmenopausal women positive for high‐risk HPV DNA with a mean age of 52 years. Of the 124 cases, 68 were positive for HPV 16 and/or 18, and 56 were positive for other high‐risk HPV. On cytology, 78% were negative for intraepithelial lesions. HSIL+ lesions were noted in 12%, and low‐grade lesions were noted in 10% of smears with HPV16/18 predominance. Follow‐up biopsies of 17 smears revealed SCC in two cases, HSIL+ in 11 cases, LSIL in 2, and 2 were negative/benign lesions. Of the cyto‐histological discordant cases, four were upgraded on review.ConclusionCytology is a useful triage tool in detecting preinvasive and early invasive tumors in HPV DNA‐positive postmenopausal women.

Assessment of cytological features of glandular lesions of the cervix on conventional smear preparations—a comprehensive study from a tertiary care hospital

AbstractBackgroundAtypical glandular cells (AGC) as a diagnostic category in cervicovaginal cytology remains as a challenge to cytopathologists.AimsThe aim of the present study is to identify the cytological features helpful in categorizing AGC as reactive or neoplastic upon correlation with histology.Materials and MethodsThe study was a retrospective review of cervical smears, with histopathological follow up, reported as glandular lesions for a period of 9 years. The architectural and nuclear features studied were adapted from The Bethesda System (TBS) to stratify the lesions as AGC, AGC‐FN (atypical glandular cells favour neoplasia) and adenocarcinoma. The cytological categories were correlated with histology.ResultsA total of 89 cases of which 67 (AGC NOS = 34, AGC FN = 19, adenocarcinoma = 14) with histology were reviewed. Neoplastic lesions were encountered in 14 cases (34.6%). Of the cases diagnosed as AGC‐NOS, AGC‐FN and adenocarcinoma, 26.5%, 68.4% and 100% respectively were neoplastic on histopathology. Squamous lesions accounted for 14.9% of all the glandular lesions. Rosette or acinar formation and loss of polarity frequently observed in neoplastic lesions as compared to reactive changes (p = 0.0004, p = 0.001). Of the nuclear features, nuclear hyperchromasia or coarse clumping of chromatin along with nuclear membrane irregularity and nuclear pleomorphism was frequently associated with neoplastic lesions as compared to reactive conditions (p = 0.007, p = 0.001, p = 0.0002).ConclusionA diagnosis of AGC at cytology harbors significant number of malignant lesions when confirmed on biopsy. Architectural features complemented with nuclear characteristics helps in differentiating between reactive and neoplastic conditions. Hence stratifying glandular lesions at cytology according to TBS helps in the management.