Role of Nuclear Morphometry in Screening of Cervical Pap Smear

Abstract

Introduction: In India, cervical cancer is the second most common cancer that leads to death in women after breast cancer. Pap smear examination is the primary test for screening cervical cells. Application of techniques like nuclear morphometry can be useful in providing an objective and reproducible diagnosis. Aim: To find the significance of nuclear morphometry pattern in differentiating between Atypical Squamous Cells of Undetermined Significance (ASC-US), Atypical Squamous Cells-Cannot Exclude High Grade Lesion (ASC-H), Low Grade Squamous Intraepithelial Lesion (LSIL), High Grade Squamous Intraepithelial Lesion (HSIL) and Squamous Cell Carcinoma (SCC). Atypical Squamous Cell: Squamous Intraepithelial Lesion (ASC:SIL) ratio was also calculated. Materials and Methods: This was a three year retrospective and two year prospective study conducted from June 2013 to July 2018 on Pap smears received in cytology laboratory of pathology department at Subharti Medical College and associated Chhatrapati Shivaji Hospital, Meerut. A total of 163 cases including 85 epithelial cell abnormality (ASC-US, ASC-H, LSIL, HSIL) and malignant cases (SCC), 78 reactive cases and 20 normal control were observed over a period of five years for which morphometric analysis was done. Cell area, cell perimeter, nuclear area, N:C ratio and nuclear diameter were noted. The mean and standard deviation were calculated and the results were compared between the different groups. Student’s t-test was used as the test of significance. Results: Majority of the cases diagnosed as reactive were in 4th decade and as epithelial cell abnormality were in 5th decade. It was observed that there was a gradual increase in nuclear area, diameter and N:C ratio from normal cell to dysplastic cell to SCC. However, mean cell area and mean cell perimeter decreased gradually for all the lesions except for ASC-H compared to LSIL and HSIL. On comparing different groups, all five parameters observed were found to be statistically significant (p<0.01). Conclusion: Nuclear morphometry if applied along with Pap smear examination can aid in differentiating and diagnosing the borderline cases and early diagnosis of squamous intraepithelial lesion.

Keywords

• cervical cancer
• cervical lesion
• morphometric analysis