title: Significance of anucleated squames in Papanicolaou-stained cervicovaginal smears.
abstract: The significance of anucleated squames in Papanicolaou-stained cervicovaginal smears as a marker of hyperkeratosis with an underlying significant atypia was evaluated. Over a two-year period, 785 (0.47%) of 168,215 cervicovaginal smears were signed out as demonstrating anucleated squames without any other abnormality. Cytologic or histologic follow-up specimens were available for 304 of those smears (42%). Histology or cytology showed condyloma or a more significant lesion in 13 cases (4.3%); histology showed hyperkeratosis without atypia in 25 cases (8.2%) and chronic cervicitis in 23 (7.5%); follow-up cytology demonstrated persistent anucleated squames in 47 cases (15.4%) and was negative in 196 (64.6%). During this same period, the rate of condyloma or a more significant lesion in all Papanicolaou smears examined was 1.69%. Thus, reporting the presence of anucleated squames in the absence of any other abnormality appears to be of marginal value as a screening procedure for predicting the existence of a significant lesion. Noting their presence in patients with a prior diagnosis of condyloma or dysplasia remains an important tool for detecting a persistent lesion. Lack of standardization among pathologists in the recognition of anucleated squames may partially explain the low predictive value of this finding: an informally conducted survey revealed a mean accuracy of 46% in the identification of true anucleated squames.
authors.affiliation: Medical Arts Laboratory, Oklahoma City, Oklahoma.
authors.forename: S B
authors.initials: SB
authors.lastname: Kern
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002584:Cervix Uteri / Q000473:pathology*; D003218:Condylomata Acuminata / Q000175:diagnosis / Q000473:pathology; D005260:Female; D006801:Humans; D007642:Keratosis / Q000175:diagnosis / Q000473:pathology; D008875:Middle Aged; D065006:Papanicolaou Test; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D002575:Uterine Cervicitis / Q000175:diagnosis / Q000473:pathology; D014626:Vaginal Smears