Usability of finding of “skewered clusters” in cervical candidiasis in liquid-based cytology

Abstract

Clusters of squamous cells skewered on the hyphae of Candida albicans like skewered chicken meat (hereafter, “skewered clusters”) are often observed in cervical specimens from patients with candidiasis examined by liquid-based cytology (LBC). In this study, we examined whether this cytological pattern observed in the LBC specimens is a characteristic finding of Candida by comparing Candida-positive and Candida-negative specimens regarding this pattern. Moreover, we examined the Candida detection rates of the direct smear method and LBC method. The frequency of skewered clusters was significantly higher in the Candida-positive specimens than in the Candida-negative specimens. In direct smears, the frequency of appearance was lower than that of LBC specimens. The SurePath method is a density-gradient-based cell enrichment process using separation reagents. The positively charged (+) slides attract the negatively charged (−) surface of cells, which were suspended in purified water on the slides for smearing. The vertically aligned squamous cells are skewered on the hyphae of Candida to form three-dimensional clusters like skewered chicken meat. On the other hand, in the direct smear method, cells are collected by scraping the cervix with a cotton swab and smeared onto the slides directly, thus, the cells and the hyphae of Candida are spread or in a one-cell-thick layer. It was found that the appearance of skewered clusters is characteristic of LBC cervical specimens (SurePath method) from patients with candidiasis. It is important to keep in mind the possibility of candidiasis when skewered clusters are detected by optical microscopy.