Contribution of DNA ploidy image cytometry to the management of ASC cervical lesions.
BACKGROUND
The Bethesda system classifies smears that suggest an underlying cervical intraepithelial neoplasia (CIN) as ASC (atypical squamous cell) smears. ASC smears are subdivided into ASCUS (of undetermined significance) and ASCH (cannot exclude a high-grade lesion). Today the management of ASCUS is a triage with HR-HPV testing and colposcopy is recommended for ASCH. The aim was to conduct a study on ASC smears to determine DNA ploidy measurement for the detection of CIN2+.


METHODS
The link between a suspect DNA ploidy assessed by image cytometry and/or a positive HR-HPV testing was analyzed on 69 ASCUS and 82 ASCH smears, and the presence of CIN2+ within 12 months after ASC diagnosis. The ploidy was suspect in case of aneuploidy, multiploidy, or in the presence of cells with a DNA content >5c or >9c.


RESULTS
Every woman who had a CIN2+ had a suspect DNA profile in the ASCUS smears and every woman except 1 was HR-HPV-positive. The link between a positive HR-HPV test or a suspect DNA profile or both and a CIN2+ was high (P = .019, .023, and .008, respectively). The presence of >9c cells was particularly linked to CIN2+ (P = .0031). In all, 90.9% and 87.9% of the ASCH smears with CIN2+ were, respectively, HR-HPV positive or had a suspect ploidy (P = .0000 and P = .0043), and the presence of >9c cells was also linked to CIN2+ (P = .003).


CONCLUSIONS
HR-HPV testing and determination of the ploidy profile with special attention to 9c-exceeding cells could be accurate for a better management of ASC smears.
Lorenzato
Marianne
M
CHU Reims, Hôpital Maison Blanche, Laboratoire Pol Bouin, Reims F-51092, France. mlorenzato@chu-reims.fr
Caudroy
Stephanie
S
Nou
Jean-Marie
JM
Dalstein
Veronique
V
Joseph
Karine
K
Bellefqih
Salima
S
Durlach
Anne
A
Thil
Corinne
C
Dez
Francine
F
Bouttens
Dominique
D
Clavel
Christine
C
Birembaut
Philippe
P
D002584:Cervix Uteri / Q000473:pathology*; D005260:Female; D006801:Humans; D027383:Papillomaviridae / Q000302:isolation & purification*; D011003:Ploidies; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*