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  • Title: Masking effect of hormonal contraceptives on discriminating quantitative features of visually normal intermediate cells in positive and negative cervical smears.
    Author: Kwikkel HJ, Boon ME, van Rijswijk MM, Rietveld WJ, Stolk JG.
    Journal: Anal Quant Cytol Histol; 1986 Sep; 8(3):227-32. PubMed ID: 3778614.
    Abstract:
    In quantitative studies of visually normal intermediate cells in smears from patients with cervical neoplasia, the contraceptive status of the patients has not previously been taken into account. In this study cervical smears from 151 patients with cervical intraepithelial neoplasia (CIN) III or invasive carcinoma and from 360 normal controls were grouped according to week of menstrual or pill cycle and mode of hormonal contraception. The nuclear-cytoplasmic (N/C) ratio of visually normal intermediate cells in smears from patients with neoplasia was significantly different from that of the normal controls (P less than .001). Based on nuclear area and N/C ratio, the percentages of intermediate cells correctly classified as having come from positive or negative smears were significantly better in women with ovulatory cycles (non-users) than in women using hormonal contraceptives (P less than .025). It is concluded that hormonal contraceptives can mask the salient quantitative features of visually normal intermediate cells from patients with CIN and the contraceptive status thus has to be taken into account in such studies. The nuclear area and nucleus to cytoplasmic (N/C) ratio were measured in visually normal intermediate cells of cervical smears from 151 women with cervical intraepithelial neoplasia (CIN III) or invasive carcinoma, and from 360 normal controls, and the effect of timing of the menstrual cycle, or pill cycle or Depo-Provera contraception was determined. Morphometry was done on visually normal, polygonal intermediate cells without signs of human papilloma virus infection, with a graphic tablet and cursor under 40x oil immersion, and data were handled by microcomputer. The N/C ratio from abnormal smears taken together differed significantly from normals (p.001), but this difference was not apparent taking individual diagnoses separately. The percentages of cells correctly classified as positive or negative were significantly better in cycling women than in those using hormonal contraception (p.025), especially so in ovulatory cycle week II. The mean percentage of correct classification of intermediate cells as coming from positive or negative smears was low in women using any type of hormonal contraception. When hormonal contraception and neoplasia were both present, the increase in N/C ratio was less than expected in some cases. Thus hormonal contraceptives can mask the quantitative features of visually normal intermediate cells from patients with cervical intraepithelial neoplasia, and their contraceptive status needs to be taken into account.
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