TITLE:
Evaluating the Importance of Apoptotic Index, Mitotic Index and Turnover Index in Premalignant and Malignant Lesions of Cervix
AUTHORS:
Subhash Bhardwaj, Farooq Ahmed Wani
KEYWORDS:
Apoptosis, Apoptotic Index, Mitosis, Cervical Carcinoma
JOURNAL NAME:
Open Journal of Pathology,
Vol.5 No.2,
March
25,
2015
ABSTRACT: Aim: To evaluate the premalignant and
malignant lesions of the uterine cervix on light microscopy for apoptosis. To
calculate and correlate the apoptotic index (AI), mitotic index (MI) and
turnover index of the lesions. Materials and methods: A 2-year retrospective
(November 2007 to October 2009) and 1-year prospective study (November 2009 to
October 2010). A total of 95 cases of premalignant and malignant lesions of
cervix were studied. The hematoxylin-eosin stained slides were screened for
apoptosis under oil immersion lens. Apoptotic index (AI) was calculated as the
number of Apoptotic cells and Apoptotic bodies, expressed as percentage of
total no. of tumour cells counted in each case. Mitotic index (MI) was
calculated by counting mitosis among 1000 tumour cells. Turnover index (TOI)
was obtained by adding MI and AI, i.e., (TOI = MI + AI). After calculating, all
these indices were correlated with different grades of the cervical lesions.
Results: Premalignant lesions were divided into four subgroups. On statistical
analysis, it was found that the difference in the apoptotic indices and
turnover indices in all the four subgroups was not statistically significant.
However for mitotic indices, significant statistical difference was found in
Subgroup II (mild dysplasia vs. moderate dysplasia) with a p value of 0.03 and
in subgroup IV (squamous metaplasia vs. moderate/severe dysplasia) with a p
value of 0.0005. Within the malignant group, we compared well differentiated
with less well differentiated subgroup. Statistical analysis revealed a
significant difference in TOI between the two subgroups of malignant tumours (p
= 0.04). Statistical comparison between premalignant and malignant group of
lesions showed a highly significant difference between the AI, MI and TOI with
p value of 0.0001. Conclusion: We conclude that proliferative and apoptotic
indices are useful in distinguishing between benign and malignant lesions of
the cervix. Proliferative activity of a lesion is a reliable indicator of its
malignant potential and together with apoptotic count gives an idea about the net
growth of a tumour.