Cytomorphological features of high‐grade intraepithelial neoplasia/carcinoma of the cervix following chemoradiotherapy

Background

Cervicovaginal cytology as a follow‐up study in women with a history of a cervical carcinoma treated with chemo‐radiotherapy (CRT) plays an important role; however, the cytomorphological characteristics for the diagnosis of high‐grade squamous intraepithelial lesions (H‐SIL) in post‐CRT patients have not been established. The aim of the study is to find the cytomorphological characteristics that support the diagnosis of H‐SIL by conventional cytology in these patients.

Materials and methods

This is a cross‐sectional study from 2009 to 2015, which includes patients with a diagnosis of squamous cell carcinoma treated with CRT, who all have cervix cytology for follow‐up and a later biopsy.

Results

We identified 82 cases, where the most frequent clinical stage was IIA1 to IIB with 26 cases (61.9%), the most common symptom was transvaginal bleeding (64.29%). The cytological characteristics that were statistically associated with the presence of a positive biopsy were the presence of a hemorrhagic background (45.2% vs. 12.5%, P = .007), high cellularity (45.2% vs. 15%, P < .001), disposition in groups/sheets (69% vs. 22.5%, P < .001), postradiotherapy changes at the background of the smear (73.8 vs. 50%, P < .001) and an increased nuclear/cytoplasmic ratio (100% vs. 22.5%, P < .001).

Conclusions

In patients with CRT, the presence of specific features can help the diagnosis of H‐SIL with excellent diagnostic performance.

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