THE BINUCLEATE SQUAMOUS-CELL - HISTOLOGIC SPECTRUM AND RELATIONSHIP TO LOW-GRADE SQUAMOUS INTRAEPITHELIAL LESIONS

The consistent histologic distinction of HPV-related precursor lesions from nonspecific epithelial changes is hampered by the fact that the scoring of nuclear atypia is subjective and nuclear alterations or cyt oplasmic halos may occur with both HPV and non-HPV-related changes. To determine the potential role of another parameter-bi- or multinucleat ed cells-in the diagnosis of HPV-related lesions, we analyzed a series of epithelial alterations for anisokaryosis, hyperchromasia, and cyto plasmic halos and correlated their presence with the maximum of binucl eate cells per high-power field (hpf) and the detection of HPV DNA. A positive correlation was seen between the presence of both anisokaryos is and hyperchromasia and the number of binucleate cells/hpf (p = 0.01 1) and the presence of HPV nucleic acids by in situ hybridization (p = 0.005). Only one of 23 (5.3%) known HPV-positive lesions did not exhi bit any binucleate cells. These findings indicate that, although binuc leation may be associated with a spectrum of both HPV and non-HPV rela ted changes, it is most conspicuous and virtually always present in as sociation with HPV-positive low-grade precursor lesions. Thus, this pa rameter may be useful to confirm the presence when other parameters su ggest the diagnosis of a low-grade squamous intraepithelial lesion.