Evaluating the Importance of Apoptotic Index, Mitotic Index and Turnover Index in Premalignant and Malignant Lesions of Cervix

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 maligCorresponding author. S. Bhardwaj, F. A. Wani 30 nant potential and together with apoptotic count gives an idea about the net growth of a tumour.