Saini Tarunpreet, Kundu Reetu, Rohilla Manish, Gupta Parikshaa, Gupta Nalini, Srinivasan Radhika, Saikia Uma Nahar, Dey Pranab
Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Cytojournal. 2024 Oct 17;21:38. doi: 10.25259/Cytojournal_86_2023. eCollection 2024.
Atypia of undetermined significance (AUS) is an indeterminate category which presents a significant challenge for pathologists and clinicians. The management options are dependent on the rate of malignancy for a given populace.
This is a retrospective analysis of 61 cases of the AUS Bethesda category III with grouping into neoplastic and non-neoplastic according to the histopathology data and clinical follow-up. Detailed cytomorphological features were analyzed and image morphometry was done using image J software. Student's -test was used.
Out of the total 61 cases, 35 were neoplastic cases of AUS (histopathology proven), and 26 were non-neoplastic (on follow-up) cases. The risk of neoplasia and risk of malignancy observed were 57.4% and 47.5%, respectively. Neoplastic cases displayed prominent intranuclear inclusions (54%) and pseudopapillary clusters (20%). Majority of non-neoplastic cases revealed fine chromatin (96%) and pale chromatin (4%) while among neoplastic cases, 14% showed pale chromatin. Neoplastic cases showed moderate to marked nuclear pleomorphism (20%) compared to non-neoplastic cases which were monomorphic to mildly pleomorphic. None of the non-neoplastic cases exhibited frequent nuclear overlapping, nuclear grooving, or nucleoli which emphasizes the need for scrutiny of smears for these features. On image morphometry, cases with malignant outcome had larger nuclear area, perimeter, diameter, and nuclear density which were statistically significant.
The study illustrates the importance of identifying subtle cytomorphological features and usefulness of image morphometry as an adjunctive objective tool in AUS cases. This helps in making an accurate cytological diagnosis which guides the treating clinician regarding surgical management or need for clinical follow-up.
意义不明确的非典型性（AUS）是一个不确定的类别，给病理学家和临床医生带来了重大挑战。管理方案取决于特定人群的恶性肿瘤发生率。
这是一项对61例贝塞斯达III类AUS病例的回顾性分析，根据组织病理学数据和临床随访结果分为肿瘤性和非肿瘤性两组。分析了详细的细胞形态学特征，并使用Image J软件进行图像形态测量。采用学生t检验。
在总共61例病例中，35例为经组织病理学证实的肿瘤性AUS病例，26例为非肿瘤性（随访后）病例。观察到的肿瘤形成风险和恶性肿瘤风险分别为57.4%和47.5%。肿瘤性病例显示出明显的核内包涵体（54%）和假乳头簇（20%）。大多数非肿瘤性病例显示细染色质（96%）和淡染色质（4%），而在肿瘤性病例中，14%显示淡染色质。与非肿瘤性病例（单形性至轻度多形性）相比，肿瘤性病例显示中度至明显的核多形性（20%）。非肿瘤性病例均未表现出频繁的核重叠、核沟或核仁，这强调了对涂片进行这些特征检查的必要性。在图像形态测量中，具有恶性结果的病例具有更大的核面积、周长、直径和核密度，差异具有统计学意义。
该研究说明了识别细微细胞形态学特征的重要性以及图像形态测量作为AUS病例辅助客观工具的实用性。这有助于做出准确的细胞学诊断，为治疗临床医生提供手术管理或临床随访需求的指导。
