Morphologic analysis of false negative SurePath® slides using Focalpoint™ GS computer-assisted cervical screening technology: An Australian experience.

Abstract

The trial results of BD FocalPoint™ GS computer assisted screening(FP) of BD SurePath(®) liquid based cervical cytology slides (SP) were published in Diagnostic Cytopathology in 2012.(1) METHOD: The FP-reviewed SP slides were compared to conventional cervical Pap smears (CON) in a split sample of 2198 routine specimens. In all 47 confirmed high grade (HG) cases, FP either selected fields of view (FOV) containing cells suspicious or diagnostic of HG (46/47), or prompted full screening of the slide (1/47) leading to detection of the HG lesion. In this study for the HG cases which were reported initially as negative (NEG) or low grade (LG), the original slides were reviewed to determine the reasons for the false negative reporting and to identify features characteristic of a HG pattern. Indicators of a high risk pattern for HG Squamous Intraepithelial lesions (HSIL) included the recognition of pale abnormal immature metaplastic cells. Indicators of a high risk pattern for HG Glandular Intraepithelial lesion (AIS) were single columnar cells with the nucleus occupying the widest area of the cell. Pavemented sheets of glandular cells and isolated mitoses were additional clues to the diagnosis. In endocervical and endometrial adenocarcinomas tumour diathesis tends to be absent in SurePath slides. Single cells with ingested neutrophils and obscured eccentric nuclei were another clue to the detection of endometrial adenocarcinoma. These morphological features are illustrated to help identify HSIL and HG glandular lesions when viewing the FOV presented by the FocalPoint(TM) GS technology.