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Abstract
A micronucleus is a small additional nucleus formed due to chromosomal loss or fragmentation. The aim of this study was to assess the utility of micronucleus count as a screening tool in cervical cancer. A total of 132 cases consisting of 42 pre-neoplastic and neoplastic cases and 90 non-neoplastic cases were studied. Only routine Papanicolaou-stained cervical smears were used. In each smear, the number of micronucleated cells and binucleated cells were counted under oil immersion and expressed as a count per 1,000 cells. The micronucleated and binucleated cell counts in pre-neoplastic, neoplastic and non-neoplastic categories were compared for statistical significance. The counts were also correlated with age, duration of marital life, number of pregnancies and abortions. The micronucleus count and the binucleated cell count were significantly higher in the high -grade squamous intraepithelial lesion (HSIL) and invasive carcinoma categories compared to low -grade squamous intraepithelial lesion (LSIL) and non-neoplastic cases. Receiver operating characteristic (ROC) curve analysis revealed that micronucleus count and binucleated cell count possess a high degree of sensitivity and specificity for identifying HSIL and invasive carcinoma. Our results reveal that micronucleus evaluation in routine Pap smears is a very useful biomarker in cervical cancer screening. The binucleated cell count increases the predictive value of this simple test.
Highlights
Cervical cancer is one of the most common cancers among women worldwide and the leading cause of cancer mortality in Indian women
The micronucleus count and the binucleated cell count were significantly higher in the high -grade squamous intraepithelial lesion (HSIL) and invasive carcinoma categories compared to low -grade squamous intraepithelial lesion (LSIL) and non-neoplastic cases
Receiver operating characteristic (ROC) curve analysis revealed that micronucleus count and binucleated cell count possess a high degree of sensitivity and specificity for identifying HSIL and invasive carcinoma
Summary
Cervical cancer is one of the most common cancers among women worldwide and the leading cause of cancer mortality in Indian women. The incidence of cervical cancer varies widely and 86 % of all cases and about 88 % of deaths due to cervical cancer occur in developing nations. India has the highest disease frequency with 134 000 cases and 73 000 deaths in 2008 [1]. The conventional Pap smear is the cheapest and most commonly used investigation in screening cervical cancer. A recent study revealed a significantly lower sensitivity for cytology in detecting CIN3 or worse compared to HPV testing (53.3% versus 92.0%) [2]. Ancillary investigations like HPV testing and p16 immunostaining can improve the sensitivity, but they are seldom used in developing nations for screening. A simple procedure which can be used in conjunction with the routine cytological analysis of conventional Pap smears would be of much use in better detection of cervical intraepithelial neoplasia
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