Atypical parakeratotic spires and HCII HPV results: Correlation in liquid-based cervicovaginal cytology specimens interpreted as ASC-US

The 2001 Bethesda System (2nd edition) indicates that parakeratosis with nuclear enlargement, hyperchromasia, irregular contours, and/or three dimensionality should prompt consideration of an interpretation of ASC-US or greater. The authors retrospectively reviewed 812 liquid-based cervicovaginal cytology samples (CVCSs) interpreted as ASC-US during an 11-month period. All slides were studied for the presence or absence of atypical parakeratotic spires (APKSs), a specific form of atypical parakeratosis. Results from corresponding Hybrid Capture 11 high risk (HR) HPV testing were recorded (blinded). Of 812 women, 28% (230/812) had APKSs and 20% (163/812) had positive HC11 assays for HR HPV. Three percent of all reflexed ASC-US vials (26/812) had both APKSs and positive HR HPV assays (sensitivity = 16%, specificity = 69%). APKSs in liquid-based CVCSs interpreted as ASC-US do not independently correlate to a positive reflex test for HR HPV (P < 0.0001). This suggests that APKSs are most often unrelated to underlying HR HPV infection. The finding of APKSs alone in CVCSs does not warrant an interpretation of SIL and should be used only in concert with other findings to label a sample as ASC-US.