By John Otrompke
CHICAGO -- November 5, 2009 -- Marked nuclear atypia in low-grade lesions are not an indication that the lesions will progress to become high-risk tumours, although they do serve as predictors that the low-grade lesions will recur, researchers noted at the American Society for Clinical Pathology (ASCP) 2009 Annual Meeting. There was no association between human papillomavirus (HPV) and nuclear atypia, either.
"Some nuclear features are uglier than others," explained Major Rosemarie Rodriguez, MD, Brooke Army Medical Center, Fort Sam Houston, San Antonio, Texas, at a presentation on October 29. "We were trying to see whether the uglier it gets, does it mean anything? In other words, would low-grade cervical lesions with nuclear atypia eventually develop into high-grade lesions? … It didn't pan out that way."
The study examined 352 consecutive cervical biopsies, divided into 321 cases without marked nuclear atypia, and 31 with atypia (defined as cases with at least 5 epithelial cells with nuclear enlargement and/or multinucleation of at least 5 nuclei). Average follow-up was 14.3 months for those with atypia and 17.9 months for those without atypia.
High-grade squamous intraepithelial lesions developed in 10.34% of the cases with atypia and 11.68% of those without atypia. While low-grade lesions recurred in 19 of 29 cases with marked nuclear atypia, they recurred in only 114 of 291 cases without atypia (P = .009).
No significant differences in HPV load were found between the 2 groups.
"We did follow up the cases for 24 months," said Dr. Rodriguez, noting that a contrary finding would have been significant, because it may have indicated that more frequent follow-up -- such as Pap smears twice a year, or a surgical procedure -- would have been called for. "Being in the military, you can't say no to your Pap test. Whatever diagnosis you get, you can't escape the follow-up," she added.
According to the literature, 60% of cases of low-grade lesions regress and 30% persist, while between 11% and 13% progress to high-grade lesions that can develop into cervical cancer.
[Presentation title: The Significance of Marked Nuclear Atypia in Grade 1 Cervical Intraepithelial Neoplasia. Abstract 26]
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