Atypical Squamous Cells in Liquid-Based Cervical Cytology: Microbiology, Inflammatory Infiltrate, and Human Papillomavirus-DNA Testing

OBJECTIVE

The aim of this study was to assess the correlation between atypical squamous cells (ASC) and inflammatory infiltrate and vaginal microbiota using cervical liquid-based cytological (SurePath®) and high-risk human papillomavirus (HR-HPV) tests.

STUDY DESIGN

A cross-sectional study was conducted using a 6-year database from a laboratory in Fortaleza (Brazil). Files from 1,346 ASC cases were divided into subgroups and results concerning inflammation and vaginal microorganisms diagnosed by cytology were compared with HR-HPV test results.

RESULTS

An absence of specific microorganisms (ASM) was the most frequent finding (ASC of undetermined significance, ASC-US = 74%; ASC - cannot exclude high-grade squamous intraepithelial lesion, ASC-H = 68%), followed by bacterial vaginosis (ASC-US = 20%; ASC- H = 25%) and Candida spp. (ASC-US = 6%; ASC-H = 5%). Leukocyte infiltrate was present in 71% of ASC-US and 85% of ASC-H (p = 0.0040), and in these specific cases HR-HPV tests were positive for 65 and 64%, respectively. A positive HR-HPV test was relatively more frequent when a specific microorganism was present, and Candida spp. was associated with HR-HPV-positive results (p = 0.0156), while an ASM was associated with negative HR-HPV results (p = 0.0370).

CONCLUSION

ASC-US is associated with an absence of inflammation or vaginosis, while ASC-H smears are associated with Trichomonas vaginalis and inflammatory infiltrate. A positive HR-HPV is associated with Candida spp. in ASC cytology.

Cervical Microbiome and Cytokine Profile at Various Stages of Cervical Cancer: A Pilot Study

Cervical cancer (CC) is caused by high-risk human papillomavirus persistence due to the immunosuppressive tumor microenvironment mediated by cytokines. Vaginal microbiota determines the presence of certain cytokines locally. We assessed the association between cervical microbiota diversity and the histopathological diagnosis of each stage of CC, and we evaluated mRNA cervical expression levels of IL-4, IL-6, IL-10, TGF-β1, TNF-α and IFN-γ across the histopathological diagnosis and specific bacterial clusters. We determined the cervical microbiota by high throughput sequencing of 16S rDNA amplicons and classified it in community state types (CST). Mean difference analyses between alpha-diversity and histopathological diagnosis were carried out, as well as a β-diversity analysis within the histological diagnosis. Cervical cytokine mRNA expression was analyzed across the CSTs and the histopathological diagnoses. We found a significant difference in microbiota's diversity in NCL-HPV negative women vs those with squamous intraepithelial lesions (SIL) and CC(p = 0.006, p = 0.036).When β-diversity was evaluated, the CC samples showed the highest variation within groups (p<0.0006) and the largest distance compared to NCL-HPV negative ones (p<0.00001). The predominant bacteria in women with normal cytology were L. crispatus and L. iners, whereas for SIL, it was Sneathia spp. and for CC, Fusobacterium spp. We found higher median cervical levels of IL-4 and TGF-β1 mRNA in the CST dominated by Fusobacterium spp. These results suggest that the cervical microbiota may be implicated in cervical cancer pathology. Further cohort studies are needed to validate these findings.

Integrating a Web-Based Whole-Slide Imaging System and Online Questionnaires in a National Cytopathology Peer Comparison Educational Program in Taiwan

OBJECTIVE

In a peer comparison educational program, transferring glass slides between laboratories and collecting responses are time- and cost-consuming. Integrating a web-based whole-slide imaging (WSI) system and online questionnaires may serve as a promising solution.

STUDY DESIGN

Five gynecologic Papanicolaou-stained smears and 5 nongynecologic slides were selected. The 10 whole-slide images were acquired by a Leica SCN-400 system and released via an Aperio eSlide Manager. Online questionnaires generated by Google Forms with access to the 10 whole-slide images were released to all the practitioners in Taiwan by e-mail. After closing the program, an online posttest feedback survey was conducted.

RESULTS

A total of 302 participants joined the gynecologic test, and 291 joined the nongynecologic test. The correct interpretation rates were 81.8-93.7% in the former and 28.5-93.1% in the latter. In the posttest feedback survey, there were 63.2% of the participants reporting first-time WSI experience, and 97.9% of them said they would like to participate in a similar program again.

CONCLUSION

Integrating a web-based WSI system and online questionnaires is an easy method to access nationwide practitioners. Participants can make interpretations using WSI even without prior experience. The model is valuable for those who want to initiate a large-scale cytopathology peer comparison educational program.