Cytologic features of high-grade squamous intraepithelial lesion in conventional slides: what is the difference between cases that perform well and those that perform poorly?
BACKGROUND
Previous studies have suggested that cases of high-grade squamous intraepithelial lesion in conventional smears and in ThinPrep specimens that are frequently misinterpreted as normal have relatively few small and hypochromatic dysplastic cells.


OBJECTIVE
To determine the cytologic differences between conventional Papanicolaou slides of high-grade squamous intraepithelial lesion that perform poorly and those that perform well.


METHODS
We compared the cytologic features of 22 cases of conventional smears with high-grade squamous intraepithelial lesion that performed poorly in the College of American Pathologists Interlaboratory Comparison Program in Gynecologic Cytology with 45 cases of conventional smears that performed extremely well.


RESULTS
Cases that performed poorly were significantly more likely to have 50 or fewer single dysplastic cells (P = .003) and to have only small dysplastic cells (P = .01). Cases that performed well were also more likely to have more than 500 dysplastic cells (P = .002), to exhibit the presence of large dysplastic cells (P < .001), and to be keratinized (P = .03). Hypochromasia and the number of groups of dysplastic cells were not correlated with performance.


CONCLUSIONS
Conventional smears with high-grade squamous intraepithelial lesion with 50 or fewer single dysplastic cells, no large dysplastic cells, and lacking keratinization are highly associated with poor performance in this program.
Renshaw
Andrew A
AA
Department of Pathology, Baptist Hospital of Miami, Miami, Fla 33176-2197, USA. Andrewr@bhssf.org
Prey
Marianne U
MU
Hodes
Lori
L
Weisson
Maggie
M
Haja
Jennifer
J
Moriarty
Ann T
AT
D002294:Carcinoma, Squamous Cell / Q000145:classification / Q000378:metabolism / Q000473:pathology*; D002452:Cell Count; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007633:Keratins / Q000378:metabolism; D065006:Papanicolaou Test; D010338:Pathology, Clinical / Q000379:methods; D002578:Uterine Cervical Dysplasia / Q000145:classification / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology*; D002583:Uterine Cervical Neoplasms / Q000145:classification / Q000378:metabolism / Q000473:pathology*; D014626:Vaginal Smears / Q000379:methods*
D007633:Keratins