Abstract
Objective: In cases of cervical carcinogenesis the gradient from low to high-grade lesions is characterized by increasing nuclear atypia and the failure of cellular differentiation. These phenotypic changes are presumed to be accompanied by increased genetic instability that can be documented using the micronucleus (MN) assay in exfoliated cervical cells. Material and methods: This blinded prospective study included 169 samples for final analysis; 119 normal cervical cytology, 18 preinvasive lesions and 33 frank carcinoma. A thin smear was prepared from each sample on a glass slide, which was then stained with acridine orange (a DNA specific dye). Around thousand cells per slide were counted under fluorescent microscope, 20-40 X magnification. Number of micro-nucleated cells and total number of micronuclei were recorded to calculate MN cell ratio and total MN ratio. Results: Micro-nucleated cells as well as the total number of micronuclei show increasing trend towards malignization. By ROC curve analysis, for MN cell ratio of 0.1999, the sensitivity is found to be as high as 91.4% with a specificity of 82.8%. Similar results were obtained when total MN ratios were analyzed. Advantage of combining both the ratios together does not confer any additional benefit in terms of sensitivity and specificity. Key words: micro-nucleus (MN); cervical cancer; lowgrade squamous intraepithelial lesion (LSIL); highgrade squamous intraepithelial lesion (HSIL). DOI: http://dx.doi.org/10.4038/sljog.v33i3.4018 Sri Lanka Journal of Obstetrics and Gynaecology 2011; 33 : 104-111
Highlights
It is true that cervical carcinoma owes the most gratifying success story in the history of oncology till date
In cases of cervical carcinogenesis the gradient from low to high-grade lesions is characterized by increasing nuclear atypia and the failure of cellular differentiation
In the population we studied 70-100% women had attained menopause in the highgrade squamous intraepithelial lesion (HSIL) and cancer groups as compared to 27% and 33% in the normal and lowgrade squamous intraepithelial lesion (LSIL) groups respectively
Summary
It is true that cervical carcinoma owes the most gratifying success story in the history of oncology till date. In cases of cervical carcinogenesis the gradient from low to high-grade lesions is characterized by increasing nuclear atypia and the failure of cellular differentiation. These phenotypic changes are presumed to be accompanied by increased genetic instability that can be documented using the micronucleus (MN) assay in exfoliated cervical cells[10]. The formation of micronuclei is considered to be an effective biomarker of diseases associated with DNA damage[12]. The micronuclei testing in the exfoliated samples is a cost effective, non-invasive method which can be a useful biomarker for the detection of human cancer risk in organs from where exfoliated cells can be obtained[13]
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