Can Mitotic Figures in Hyperchromatic Crowded Groups be Cytodiagnostic Criteria for High-Grade Squamous Intra-epithelial Lesions?

Hisae Suzuki; Yumeno Kondo; Chihiro Oda; Takeshi Nishikawa; Mao Takeuchi; Shigenobu Tatsumi; Sho Hosokawa; Satoshi Irino; Tomoko Uchiyama; Tomomi Fujii; Yoshiaki Norimatsu

doi:10.4103/joc.joc_156_23

Can Mitotic Figures in Hyperchromatic Crowded Groups be Cytodiagnostic Criteria for High-Grade Squamous Intra-epithelial Lesions?

J Cytol. 2024 Apr-Jun;41(2):116-122. doi: 10.4103/joc.joc_156_23. Epub 2024 Apr 24.

Authors

Hisae Suzuki¹, Yumeno Kondo², Chihiro Oda², Takeshi Nishikawa¹, Mao Takeuchi¹, Shigenobu Tatsumi¹, Sho Hosokawa^{2

3}, Satoshi Irino⁴, Tomoko Uchiyama⁵, Tomomi Fujii⁵, Yoshiaki Norimatsu^{2

3}

Affiliations

¹ Department of Pathology, Nara Medical University Hospital, Nara, Japan.
² Department of Medical Technology, The Graduate School of Ehime Prefectural University of Health Sciences, Ehime, Japan.
³ Department of Medical Technology, Faculty of Health Sciences, Ehime Prefectural University of Health Sciences, Ehime, Japan.
⁴ Department of Nursing, Faculty of Health Sciences, Ehime Prefectural University of Health Sciences, Ehime, Japan.
⁵ Department of Diagnostic Pathology, Nara Medical University, Nara, Japan.

Abstract

Aims: The present study aimed to investigate whether the presence of mitoses in hyperchromatic crowded groups (HCGs) in cervical cytological specimens can serve as cytological criteria for high-grade squamous intra-epithelial lesions (HSILs).

Methods and material: Various parameters were examined, including the frequency of mitotic figures per high power field (HPF) in Pap, hematoxylin eosin (HE) samples, and PHH3 immunocytochemical (ICC) and immunohistochemical (IHC) analyses.

Results: In the Pap and PHH3-ICC samples, the number of mitotic figures observed in HCGs was significantly higher in HSIL (P < 0.001) compared to other groups. Furthermore, the frequency of observing two or more mitoses was significantly higher in HSIL (Pap: P = 0.002, PHH3-ICC: P < 0.001) than in low-grade squamous intra-epithelial lesions (LSILs). Moreover, a comparison between Pap samples and PHH3-ICC showed that the frequency of two or more mitoses was significantly higher in the PHH3-ICC analysis of HSIL (P = 0.042). Regarding HE and PHH3-IHC samples, counting the number of mitoses in the lower and middle/upper layers of the squamous epithelial layer revealed that HSIL had a significantly higher value (HE: P = 0.0089, PHH3-IHC: P = 0.0002) than LSIL in the middle/upper layers.

Conclusions: Hence, the presence of two or more mitotic figures in HCGs per HPF in cervical cytology indicates a suspicion of HSIL. The detection of mitoses in PHH3-ICC samples is more sensitive and easier to observe than in Pap samples, making it a valuable mitotic marker.

Keywords: Cytodiagnostic criteria; endocervical cytology; high-grade squamous intra-epithelial lesions; hyperchromatic crowded groups; mitotic figures.