Cytomorphological assessment of benign and malignant dense hyperchromatic groups in cervicovaginal smears.

Dense hyperchromatic cell groups are considered common diagnostic problems in cytopathological evaluations. Clusters of cells with scant cytoplasm and dark nuclei represent the morphological features of dense hyperchromatic cells. Cytological evaluations of the dense hyperchromatic groups in cervicovaginal smear results in high rates of false-positive or false negative diagnosis. The key element is to differentiate among the dense hyperchromatic groups and to appropriately classify, based on strict morphologic criteria. The objective of this study was to evaluate the cytomorphology of benign and malignant dense hyperchromatic groups in cervicovaginal smears reported at the University of Mississippi Medical Center. Six distinct types of dense hyperchromatic groups were selected (forty-eight cervicovaginal smears) to represent all of the entities. The cases were divided into; group 1; atrophic pattern (n = 9), group 2; endocervical cells (n = 9); group 3, endometrial cells (n = 10), group 4; high-grade squamous lesions (HSIL)(n = 10), group 5; squamous cell carcinoma (n = 5), and group 6; endometrial adenocarcinoma (n = 5). Light microscope techniques were used to evaluate several parameters--such as, background, arrangement, and chromatin pattern. ImagePro digital analysis computer software (at x40 magnification) was used to quantify and evaluate the nuclear area and nuclear to cytoplasm ratio. Data obtained from this investigation suggest that there were significant differences observed in the total nuclear areas among all groups. In conclusion, cytomorphometric analysis can be utilized as an ideal diagnostic tool in differentiating between the ambiguous or suspicious groups of dense hyperchromatic cells. Ultimately, this diagnostic tool can minimize the rate of false-positive or false-negative diagnosis resulting in better cytologic evaluations and patient management.