Atypical bare nuclei in liquid-based cervical cytology and their significance

Objective To investigate the potential significance of atypical bare nuclei in ThinPrep (TP) technique (Cytyc Corp., Boxborough, Massachusetts, U.S.A.), liquid-based cervical cytology and their possible association with certain epithelial abnormalities. Study design Four thousand seven hundred thirty-six TP cervical smears were reviewed over a period of 13 months. Cases in which atypical bare nuclei were detected were selected and were further studied for the clinical, cytomorphologic and histologic features associated with each case. Cases with "typical" bland-looking, free nuclei were excluded. Results Ten cases were found to have atypical bare nuclei in the reviewed TP cervical smears. Nine were found to be associated with high grade squamous intraepithelial lesions (HSILs) and 6 were nonkeratinizing-type HSIL, 5 of which had endocervical involvement. None were associated with low grade squamous intraepithelial lesions (LSILs). One was associated with endometrial serous papillary carcinoma. Conclusion In this study we tried to illustrate the significance of atypical bare nuclei in TP cervical smears. An association of atypical bare nuclei with HSIL, but not with LSIL, was observed. Attempts were made to explain this association and to suggest the potential management implications for TP cervical smears with such atypical bare nuclei.