Evaluation of premalignant and malignant lesions in conventional pap smears by nuclear morphometry: a prospective observational study.

Dr. Yerraguntla Divyaprafulla; Mounika Reddy Guntaka; HimaBindu G

doi:10.51168/5h2zha36

Authors

Dr. Yerraguntla Divyaprafulla Associate Professor ,Department of pathology, Kamineni institute of Medical Sciences, Narketpally, Telangana
Dr.Mounika Reddy Guntaka Assistant Professor, Department of Pathology, Katuri Medical College and Hospital,Andhra Pradesh
Dr.HimaBindu G Professor and Head, Department of Pathology Kamineni institute of Medical Sciences, Narketpally,Telangana

DOI:

https://doi.org/10.51168/5h2zha36

Keywords:

Nuclear morphometry, Papanicolaou smear, Low-grade squamous intraepithelial lesion, High-grade squamous intraepithelial lesion, Squamous cell carcinoma, Bethesda system

Abstract

Background:

Cervical cancer remains a major preventable malignancy among women, and conventional Papanicolaou smear screening is central to early detection. However, borderline cytological interpretation between premalignant and malignant lesions is sometimes subjective.

Objectives:

To evaluate cellular and nuclear morphometric parameters in conventional Pap smears and to assess their usefulness in differentiating low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion, and squamous cell carcinoma.

Methods:

This prospective cross-sectional observational study was conducted in the Department of Pathology, Kamineni Institute of Medical Sciences, Narketpally, Telangana, from February 2025 to March 2026. Among 1,200 conventional Pap smears assessed during the study period, all 100 cases meeting the predefined specimen-quality criteria and having histopathological confirmation were included. Smears were classified using the Bethesda system. Digital images were analysed with ImageJ 1.44c software, and approximately 25 well-preserved, non-overlapping nuclei per case were assessed.

Results:

The age range was 21-70 years. The study included 37 normal, 23 reactive, 10 atypical squamous cells of undetermined significance, 15 low-grade squamous intraepithelial lesion (LSIL), 10 high-grade squamous intraepithelial lesion (HSIL), and 5 squamous cell carcinoma (SCC) smears. Nuclear area increased from 104.14 ± 13.89 in LSIL to 112.49 ± 21.58 in HSIL and 152.81 ± 24.58 in SCC (p<0.001). Nuclear perimeter was 108.97 ± 8.07, 111.01 ± 11.53, and 132.52 ± 7.34, respectively (p<0.001); nuclear diameter was 11.58 ± 0.69, 12.27 ± 1.10, and 14.12 ± 0.97 (p<0.001); and the nuclear-to-cytoplasmic ratio was 0.102 ± 0.030, 0.160 ± 0.028, and 0.222 ± 0.033 (p<0.001).

Conclusion:

Nuclear morphometry served as a useful objective adjunct for distinguishing premalignant and malignant cervical cytology categories.

Recommendations:

Nuclear morphometry should be incorporated as a supportive tool in borderline Pap smear interpretation, especially for differentiating low-grade, high-grade, and malignant squamous lesions.

Author Biographies

Dr. Yerraguntla Divyaprafulla, Associate Professor ,Department of pathology, Kamineni institute of Medical Sciences, Narketpally, Telangana

is currently working as an Associate Professor in the Department of Pathology at Kamineni Institute of Medical Sciences, Narketpally, Telangana, India. She completed her MBBS from Zaporozhyte State Medical University, Ukraine, followed by an MD in Pathology from B. M. Patil Medical College, Vijayapura, Karnataka, India. She has 7 years of teaching experience and is actively involved in academic pathology, cytopathology, and medical research. ORCID iD: https://orcid.org/0000-0001-8802-8152
Dr.Mounika Reddy Guntaka, Assistant Professor, Department of Pathology, Katuri Medical College and Hospital,Andhra Pradesh

is currently working as an Assistant Professor in the Department of Pathology at Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India. She completed her MBBS from Chongqing Medical University, China, followed by MD Pathology from the upgraded Department of Pathology, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinavutapalli, Andhra Pradesh, India. She has 4 years of teaching experience and is involved in undergraduate teaching, diagnostic pathology, and research activities.
Dr.HimaBindu G, Professor and Head, Department of Pathology Kamineni institute of Medical Sciences, Narketpally,Telangana

is currently working as Professor and Head, Department of Pathology, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India. She completed both MBBS and MD Pathology from NRI Medical College, Chinakakani, Mangalagiri, Guntur district, Andhra Pradesh, India. She has 11 years of teaching experience and has contributed to academic training, diagnostic pathology services, departmental administration, and research guidance.

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