Cytomorphologic and Clinical Factors of Having High-Grade Cervical Intraepithelial Neoplasia/Invasive Carcinoma in Women with Atypical Squamous Cells, Cannot Exclude High-Grade Squamous Intraepithelial Lesion (ASC-H) Smears
Thiti Atjimakul MD*, Sathana Boonyapipat MD*, Saibua Chichareon MD*, Monlika Phukaoloun MD**
Affiliation : * Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand ** Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
Objective : To determine the predictors for high-grade cervical intraepithelial neoplasia (CIN)/invasive carcinoma in women
with atypical squamous cells, cannot exclude the high-grade squamous intraepithelial lesion (ASC-H) smears.
Material and Method: All women with ASC-H, who underwent colposcopy and had histolopathologic diagnosis between
January 2004 and December 2011, were recruited. Clinical and cytomorphologic features were correlated with final
histological diagnosis. Univariate and multivariate analysis were used to determine predicting factors for high-grade CIN/
invasive cancer.
Results : Among 136,638 smears performed, 193 (0.14%) smears were reported as ASC-H and 121 smears were available
for review. The underlying pathology were negative/reactive (N/R) 57 (47.1%), CIN 1 23 (19.0%), CIN 2-3 39 (32.0%), and
invasive cancer 2 (1.6%). On univariate analysis, predicting factors of having high-grade CIN included a high N/C ratio,
greater nuclear hyperchromasia, nuclear membrane irregularities, and the coarse chromatin. The multivariate analysis
showed that a high nuclear-to-cytoplasmic (N/C) ratio (OR = 8.6, 95% CI = 1.1-70.1) and greater nuclear hyperchromasia
(OR = 5.8, 95% CI = 1.6-20.8) were the independent predictors for high-grade CIN or invasive carcinoma.
Conclusion : The presence of a high N/C ratio and greater nuclear hyperchromasia could be used to predict high-grade
CIN or invasive carcinoma in ASC-H smears.
Keywords : Atypical squamous cells, High-grade squamous intraepithelial lesion, Cervical smears, Cervical cancer
