Significance of bizarre cells in cervical screening liquid‐based cytology: A prospective study of 15 cases

• Published in: Cytopathology (Oxford) 2018-02, Vol.29 (1), p.58-62
• Main Authors: Ondič, O., Ferko, R., Kičinová, J., Bouda, J., Kinkorová‐Luňáčková, I., Kupcová, L., Zůchová, M., Chytra, J., Waloschek, T., Tůmová Bartošková, M., Alaghehbandan, R., Němcová, J.
• Format: Article
• Language: English
• Subjects: ASC‐H; Atypical Squamous Cells of the Cervix - pathology; Biopsy; Cellular biology; cervix; Cytology; Cytoplasm; Diagnosis; Epithelium; Female; high‐grade squamous intraepithelial lesion; Histology; Human papillomavirus; Humans; Hysterectomy; Liquid Biopsy; liquid‐based cytology; Medical screening; multinucleation; Papanicolaou Test; Squamous cells; Squamous Intraepithelial Lesions of the Cervix - diagnosis; Squamous Intraepithelial Lesions of the Cervix - pathology; Vaginal Smears
• ISSN: 0956-5507; 1365-2303
• DOI: 10.1111/cyt.12494

Objective The aim of this study was to assess the significance of bizarre cells (cells of squamous origin with a superficial squamous cell‐type cytoplasm and characterised by multinucleation that produces bizarre nuclear shapes) in liquid‐based cytology (LBC) Papanicoaou (pap) smears with clinical and histological follow‐up correlation. Methods Fifteen patients, all with LBC samples containing bizarre cells, were identified in routine ThinPrep® LBC workload. HPV testing was performed in each case using residual LBC material. Cytological‐histological correlations were reviewed. Results All 15 LBC samples contained bizarre cells and tested positive for high‐risk HPV types. Ten of the 15 cases were identified as atypical squamous cells ‐ cannot exclude an HSIL (ASC‐H) with secondary diagnosis of low‐grade squamous intraepithelial lesion (LSIL), while five cases were identified as high‐grade squamous intraepithelial lesion (HSIL), and a subsequent biopsy was recommended. Additionally, 13/15 cases underwent cone biopsy or hysterectomy within 1‐11 months, of which 10 showed histologically confirmed HSIL end‐points. LSIL was present in three cases. Bizarre cells were identified in the HSIL epithelium of five cone biopsies. Conclusions Identification of bizarre cells in LBC is straightforward and may facilitate diagnosis. The cytology of bizarre cells is associated with HSIL in cone biopsies. We recommend assigning LBC samples containing bizarre cells as ASC‐H with secondary diagnosis of LSIL. Identification in LBC samples of bizarre cells–squamous cells of superficial level size characterized by multinucleation producing bizarre nuclear shapes–is straightforward but probably under‐reported. These cells are often associated with HSIL on histology. We recommend reporting LBC samples containing bizarre cells as ASC‐H with secondary diagnosis of LSIL.