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Xu H, Chen Y, Zhao C, Wang Q, Tang M, Zhang W, Wang Q, Lou R, Liu T, Feng Y, Zhang H. Bethesda system reporting rates, histological follow-up and HPV genotypes distribution of abnormal cytology in Anhui province of China: Analysis of 93,168 cervical liquid-based cytology test reports. Diagn Cytopathol 2023. [PMID: 37114437 DOI: 10.1002/dc.25150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To analyze the Bethesda System reporting rates, histological follow-up, and HPV genotypes distribution of abnormal cytology in Anhui province of China. METHODS According to the Bethesda Reporting System of Cervical Cytology (2014), a retrospective analysis of the cervical liquid-based cytology (LBC) results, abnormal cytology with concurrent HPV genotype testing, and immediate histological follow-up. HPV genotype testing was performed for 15 High-risk types and 6 Low-risk types. Immediate histological correlation results within 6 months after the LBC and HPV results. RESULTS 6.70% of women with abnormal LBC results, and ASC/SIL was 1.42. The severe histological results in abnormal cytology were ASC-US (18.58%), ASC-H (53.76%), LSIL (16.62%), HSIL (82.07%), SCC/ACa (100.00%), AGC (63.77%). The total HPV-positive rate in abnormal cytology was 70.29%, of which ASC-US, ASC-H, LSIL, HSIL, SCC/ACa, and AGC were 60.78%, 80.83%, 83.05%, 84.93%, 84.51%, 33.33%. The top three detected genotypes were HR HPV 16, 52, and 58. The most commonly detected genotype in HSIL and SCC/ACa was HPV 16. Of the 91 AGC patients, 34.78% were cervical lesions, and 42.03% were endometrial lesions. The HPV-positive rate in the group of AGC-FN was highest and lowest in the group of AGC-EM. CONCLUSION The Bethesda System reporting rates of cervical cytology were all within the benchmark range of the CAP laboratory. HPV 16, 52, and 58 were the most common genotypes in our population, and HPV 16 infection has a higher degree of malignancy of cervical lesions. Among patients with ASC-US results, HPV positive patients had a higher rate of biopsy-detected CIN2+ than HPV negative patients.
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Affiliation(s)
- Hongliang Xu
- Department of Pathology, Anhui Province Maternity and Child Health Hospital, Anhui Medical University, Hefei, China
| | - Yong Chen
- Department of Pathology, Anhui Province Maternity and Child Health Hospital, Anhui Medical University, Hefei, China
| | - Caixia Zhao
- Department of Pathology, Anhui Province Maternity and Child Health Hospital, Anhui Medical University, Hefei, China
| | - Qin Wang
- Department of Pathology, Anhui Province Maternity and Child Health Hospital, Anhui Medical University, Hefei, China
| | - Man Tang
- Department of Pathology, Anhui Province Maternity and Child Health Hospital, Anhui Medical University, Hefei, China
| | - Weiqin Zhang
- Department of Pathology, Anhui Province Maternity and Child Health Hospital, Anhui Medical University, Hefei, China
| | - Qing Wang
- Department of Pathology, Anhui Province Maternity and Child Health Hospital, Anhui Medical University, Hefei, China
| | - Rong Lou
- Department of Pathology, Anhui Province Maternity and Child Health Hospital, Anhui Medical University, Hefei, China
| | - Tingting Liu
- Department of Pathology, Anhui Province Maternity and Child Health Hospital, Anhui Medical University, Hefei, China
| | - Yi Feng
- Department of Pathology, Anhui Province Maternity and Child Health Hospital, Anhui Medical University, Hefei, China
| | - Heping Zhang
- Department of Pathology, Anhui Province Maternity and Child Health Hospital, Anhui Medical University, Hefei, China
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Almeida G, Sainz JE, Fonseca R, Chaves N, Silva KS, Nunes J, Furtado Y. Preventing Uterine Cervix Cancer: The Clinical Meaning of Atypical Glandular Cells. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:483-488. [PMID: 35139566 PMCID: PMC9948133 DOI: 10.1055/s-0042-1742318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine the prevalence of the atypical glandular cells (AGCs) cytology and to analyze its clinical significance in different age ranges. METHODS Retrospective observational study using computerized data from the Brazilian National Cancer Institute, including women screened between January 2002 and December 2008. The women included were those with an AGC result who were properly followed-up with colposcopy and a second cytology. RESULTS A total of 132,147 cytopathological exams were performed during the study period. Five-hundred and thirty-three (0.4%) women with AGC cytology were identified and, of these, 69.41% (370/533) were properly referred for colposcopy and a new cytology. Most of the women (79.2%) with a 1st or 2nd AGC cytology were between the ages of 25 and 54 years. The 2nd cytology demonstrated 67.6% (250/370) of normality, 24.5% (91/370) of squamous atypia, and 6.2% (23/370) of AGC, 0.8% (3/370) adenocarcinoma in situ and 0.8% (3/370) adenocarcinoma invasor. On biopsy of the women with a second AGC cytology, 43.4% (10/23) had normal histology, 43.4% (10/23) had squamous lesions, 8.7% (2/23) had invasive adenocarcinoma, and 1.2% (1/23) had an inconclusive report. All of the women with high-grade squamous intraepithelial lesion (HSIL) or invasive adenocarcinoma (respectively 5 and 2 patients), after a 2nd AGC cytology were 25 years old or older. CONCLUSION The prevalence of the AGC cytology was low in the studied population. Most of the AGC cytology cases occurred in adult women between the ages of 25 and 54. Although most of the patients had normal histology after follow-up, several of them presented with squamous intraepithelial lesions or invasive adenocarcinoma.
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Affiliation(s)
| | | | - Renata Fonseca
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Neil Chaves
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Julio Nunes
- Department of Psychiatry and Behavior Sciences, Stanford University, Stanford, CA, United States
| | - Yara Furtado
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Jang TK, Park JY, Kim DY, Suh DS, Kim JH, Kim YM, Kim YT, Nam JH. The Clinical Significance and Utility of HPV-DNA Testing in Korean Women with Atypical Glandular Cells in Cervical Pap Tests: An Analysis of 311 Cases at a Single Institution. Cancer Invest 2021; 39:885-892. [PMID: 34279158 DOI: 10.1080/07357907.2021.1952593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of this study is to analyze the correlation between clinically significant histologic results and HPV in women with AGC in pap test. Of the 311 women confirmed as AGC, 111 women (35.7%) was identified as positive for HPV. In the AGC analysis, cervical lesions were significantly more common in HPV positive group compared to HPV negative group (61.2 vs. 10.5%, p < 0.001). In contrast, endometrial lesions were not associated with HPV infection (8.1 vs. 4.5%, p = 0.12). The HPV-DNA testing in women with AGC may be a useful tool for predicting clinically significant cervical lesions.
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Affiliation(s)
- Tae-Kyu Jang
- Department of Obstetrics and Gynecology, Donsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Jeong-Yeol Park
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae-Yeon Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae-Shik Suh
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Hyeok Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Man Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Tak Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joo-Hyun Nam
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Liu S, Gibbons-Fideler IS, Tonkovich D, Shen R, Li Z. The reporting rates of atypical glandular cells and their HPV testing and histologic follow-up results: a comparison between ThinPrep and SurePath preparations from a single academic institution. J Am Soc Cytopathol 2019; 8:128-132. [PMID: 31097288 DOI: 10.1016/j.jasc.2018.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 11/19/2018] [Accepted: 11/24/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The interpretation of atypical glandular cells (AGCs) remains a major challenge in gynecologic cytopathology using liquid-based cytology (LBC) (ThinPrep and SurePath). The comparison of performance of detecting glandular abnormalities using these 2 methods is lacking. We investigated the reporting rates of AGCs, human papillomavirus (HPV) testing, and histologic follow-up results in ThinPrep (TP) and SurePath (SP) samples. MATERIALS AND METHODS In our institution, both TP and SP were utilized during the period between January 2014 and June 2017. A retrospective search was conducted to identify patients with AGCs from 58,591 LBCs (27,041 TP and 31,550 SP). Roche (Pleasanton, CA) cobas HPV testing and histologic follow-up results were collected. RESULTS The reporting rates of AGCs for TP (0.7%) or SP (0.2%) were within the College of American Pathologists benchmark ranges, but the reporting for TP was significantly greater than that for SP (P < 0.0001). The HPV-positive rates were 26.0% and 19.4% in TP-AGCs and SP-AGCs, respectively, with no statistical significance. A total of 137 (74.9%) TP-AGCs and 54 (74%) SP-AGCs had histologic follow-up. High-grade squamous intraepithelial lesions (HSIL)/squamous cell carcinoma were identified in 8.8% (12 of 137) of TP-AGCs and 13% (7 of 54) of SP-AGCs. Adenocarcinomas including endocervical and endometrial adenocarcinomas were identified in 9.5% (13 of 137) of TP-AGCs and 13% (7 of 54) of SP-AGCs. Together, 18.2% (25 of 137) of TP-AGCs and 25.9% (14 of 54) of SP-AGCs showed either HSIL or carcinoma in histologic follow-up, but with no statistical significance. CONCLUSIONS TP preparation detected considerably more AGCs than SP preparation. There was no statistical significant difference in HPV-positive rates or histologic follow-up outcomes between TP-detected AGCs and SP-detected AGCs.
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Affiliation(s)
- Shiguang Liu
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Dena Tonkovich
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Rulong Shen
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Zaibo Li
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Ruipérez Pacheco E, Ramírez Mena M, García Santos F, Bellón del Amo M, Coronado Martín P. Diagnóstico citológico de «células glandulares atípicas» como predictor de enfermedad ginecológica oncológica. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2019. [DOI: 10.1016/j.gine.2018.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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6
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Significance of high-risk HPV detection in women with atypical glandular cells on Pap testing: Analysis of 1857 cases from an academic institution. Cancer Cytopathol 2016; 125:205-211. [DOI: 10.1002/cncy.21791] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/15/2016] [Accepted: 09/06/2016] [Indexed: 11/07/2022]
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Pradhan D, Li Z, Ocque R, Patadji S, Zhao C. Clinical significance of atypical glandular cells in Pap tests: An analysis of more than 3000 cases at a large academic women's center. Cancer Cytopathol 2016; 124:589-95. [DOI: 10.1002/cncy.21724] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 03/26/2016] [Accepted: 03/29/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Dinesh Pradhan
- Department of Pathology; Magee-Womens Hospital, University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Zaibo Li
- Department of Pathology; Magee-Womens Hospital, University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Rebecca Ocque
- Department of Pathology; Magee-Womens Hospital, University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Stell Patadji
- Department of Pathology; Magee-Womens Hospital, University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Chengquan Zhao
- Department of Pathology; Magee-Womens Hospital, University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
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Kanber Y, Charbonneau M, Auger M. Pap smears with glandular cell abnormalities: Are they detected by rapid prescreening? Cancer Cytopathol 2015; 123:739-44. [PMID: 26348845 DOI: 10.1002/cncy.21601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 07/01/2015] [Accepted: 07/07/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Rapid prescreening (RPS) is one of the quality assurance (QA) methods used in gynecologic cytology. The efficacy of RPS has been previously studied but mostly with respect to squamous lesions; in fact, there has been no study so far specifically looking at the sensitivity of RPS for detecting glandular cell abnormalities. METHODS A total of 80,565 Papanicolaou (Pap) smears underwent RPS during a 25-month period. A sample was designated as "review for abnormality" (R) if any abnormal cells (at the threshold of atypical squamous cells of undetermined significance/atypical glandular cells [AGC]) were thought to be present or was designated as negative (N) if none were detected. Each sample then underwent full screening (FS) and was designated as either R or N and also given a cytologic interpretation. RESULTS The final cytologic interpretation was a glandular cell abnormality (≥AGC) in 107 samples (0.13%); 39 of these (36.4%) were flagged as R on RPS. Twenty-four patients (33.8%) out of 71 who had histologic follow-up were found to harbor a high-grade squamous intraepithelial lesion or carcinoma; 13 of those 24 Pap smears (54.2%) had been flagged as R on RPS. Notably, 11 AGC cases were picked up by RPS only and not by FS and represented false-negative cases; 2 of these showed endometrial adenocarcinoma on histologic follow-up. CONCLUSIONS Pap smears with glandular cell abnormalities are often flagged as abnormal by RPS, and this results in a sensitivity of 36.4% (at the AGC threshold). Most importantly, some cases of AGC are detected on Pap smears by RPS only, and this demonstrates that RPS is a valuable QA method.
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Affiliation(s)
- Yonca Kanber
- Department of Pathology, McGill University, Montreal, Canada.,Department of Pathology, McGill University Health Center, Montreal, Canada
| | | | - Manon Auger
- Department of Pathology, McGill University, Montreal, Canada.,Department of Pathology, McGill University Health Center, Montreal, Canada
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Chen L, Booth CN, Shorie JA, Brainard JA, Zarka MA. Atypical endometrial cells and atypical glandular cells favor endometrial origin in Papanicolaou cervicovaginal tests: Correlation with histologic follow-up and abnormal clinical presentations. Cytojournal 2014; 11:29. [PMID: 25506385 PMCID: PMC4253043 DOI: 10.4103/1742-6413.144686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 09/05/2014] [Indexed: 11/18/2022] Open
Abstract
The 2001 Bethesda system recommends further classifying atypical glandular cells (AGCs) as either endocervical or endometrial origin. Numerous studies have investigated the clinical significance of AGC. In this study, we investigated the incidence of clinically significant lesions among women with liquid-based Papanicolaou cervicovaginal (Pap) interpretations of atypical endometrial cells (AEMs) or AGC favor endometrial origin (AGC-EM). More importantly, we correlated patients of AEM or AGC-EM with their clinical presentations to determine if AEM/AGC-EM combined with abnormal vaginal bleeding is associated with a higher incidence of significant endometrial pathology. All liquid-based Pap tests with an interpretation of AEM and AGC-EM from July, 2004 through June, 2009 were retrieved from the database. Women with an interpretation of atypical endocervical cells, AGC, favor endocervical origin or AGC, favor neoplastic were not included in the study. The most severe subsequent histologic diagnoses were recorded for each patient. During this 5-year period, we accessioned 332,470 Pap tests of which 169 (0.05%) were interpreted as either AEM or AGC-EM. Of the 169 patients, 133 had histologic follow-up within the health care system. The patients ranged in age from 21 to 71 years old (mean 49.7). On follow-up histology, 27 (20.3%) had neoplastic/preneoplastic uterine lesions. Among them, 20 patients were diagnosed with adenocarcinoma (18 endometrial, 1 endocervical, and 1 metastatic colorectal), 3 with atypical endometrial hyperplasia, and 4 with endometrial hyperplasia without atypia. All patients with significant endometrial pathology, except one, were over 40 years old, and 22 of 25 patients reported abnormal vaginal bleeding at the time of endometrial biopsy or curettage. This study represents a large series of women with liquid-based Pap test interpretations of AEM and AGC-EM with clinical follow-up. Significant preneoplastic or neoplastic endometrial lesions were identified in 20.3% of patients. Patients with Pap test interpretations of AEM or AGC-EM and the clinical presentation of abnormal vaginal bleeding should be followed closely.
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Affiliation(s)
- Longwen Chen
- Address: Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA ; Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Christine N Booth
- Address: Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Julie A Shorie
- Address: Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jennifer A Brainard
- Address: Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew A Zarka
- Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
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Zhao C, Li Z. Automated cell block system for atypical glandular cells of cervical cytology: is it feasible? Cancer Cytopathol 2013; 122:5-7. [PMID: 24302612 DOI: 10.1002/cncy.21368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 10/08/2013] [Accepted: 10/10/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Chengquan Zhao
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Goyal A, Yang B. Cytologic features of stratified mucin producing intraepithelial lesion of the cervix--a case report. Diagn Cytopathol 2013; 42:792-7. [PMID: 24574375 DOI: 10.1002/dc.23066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 09/04/2013] [Accepted: 10/10/2013] [Indexed: 11/11/2022]
Abstract
Stratified mucin-producing intraepithelial lesion (SMILE) of the cervix is a human papilloma virus (HPV) associated high grade intraepithelial columnar cell neoplasm that is thought to arise from the reserve cells of the transformation zone. It is composed of immature stratified cells that display intracytoplasmic mucin and is commonly associated with high grade squamous intraepithelial lesion (HSIL), adenocarcinoma in situ (AIS), and invasive carcinoma. Here, we describe the cytologic features of SMILE and discuss its pitfalls in cervical cytology. A 51-year-old woman was diagnosed with SMILE on a cervical biopsy. Histologically, the dysplastic epithelium showed enlarged nuclei with increased nuclear density and presence of mucin-producing columnar cells throughout its thickness. The slides from the last two Pap tests (ThinPrep) performed on the patient were reviewed and compared with the histology. Cytologically, groups of atypical endocervical glandular cells were seen on both Pap tests. These groups showed mild nuclear crowding, slightly enlarged nuclei, nuclear hyperchromasia, and indistinct nucleoli. The borders of these cell groups were relatively smooth. Original cytologic diagnosis was atypical squamous cells of undetermined significance (ASC-US) in both instances. HPV (Hybrid Capture 2) testing was positive on both occasions. Similar to the histology, cytologic features of SMILE are subtle. The features are not typical for AIS or for HSIL and could easily be misinterpreted as reactive. This report emphasizes that careful review of crowded groups of glandular cells in HPV positive women is absolutely critical. Based on our knowledge, this is the first description of the cytologic features of these lesions.
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Xing W, Hou AY, Fischer A, Owens CL, Jiang Z. The cellient automated cell block system is useful in the differential diagnosis of atypical glandular cells in Papanicolaou tests. Cancer Cytopathol 2013; 122:8-14. [DOI: 10.1002/cncy.21343] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 07/08/2013] [Accepted: 07/15/2013] [Indexed: 01/23/2023]
Affiliation(s)
- Wei Xing
- Department of Pathology; University of Massachusetts Medical Center; Worcester Massachusetts
| | | | - Andrew Fischer
- Department of Pathology; University of Massachusetts Medical Center; Worcester Massachusetts
| | - Christopher L. Owens
- Department of Pathology; University of Massachusetts Medical Center; Worcester Massachusetts
| | - Zhong Jiang
- Department of Pathology; University of Massachusetts Medical Center; Worcester Massachusetts
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Abstract
OBJECTIVE This study seeks to determine whether an association exists between atypical glandular cells (AGC) on cervical cytology and breast disease. METHODS We analyzed 470,147 Papanicolaou test results from January 1, 2002, to November 17, 2008, inclusive. We studied all cases of AGC versus a control group with normal Papanicolaou test results. The database was then searched to determine which of these women had a history of breast disease. A comparison of the prevalence of breast disease between the two groups was performed. RESULTS Of the 470,147 total Papanicolaou tests, 1,087 cases of AGC (0.23%) were identified from 1,026 women. There were 1,064 women comprising the normal population. The mean ± SD age of these two groups was 44.9 ± 13.7 and 41.6 ± 14.4 years, respectively. Among the women with an AGC on Papanicolaou testing, 40 (3.9%) had breast disease compared with 21 (2.0%) among those without an AGC on Papanicolaou testing (P = 0.009). Among the 40 women with an AGC on their Papanicolaou test and breast disease, 7 (17.5%) also had a concerning gynecologic (Gyn) pathologic finding at the level of the cervix, endocervix, or uterus. In comparison, the women with normal Papanicolaou test results had no Gyn pathologic findings. CONCLUSIONS The prevalence of an abnormal Gyn pathologic finding in those with AGC is consistent with prior data. Women from this data set who have an AGC on Papanicolaou testing have a statistically higher likelihood of having concurrent breast disease. Further data are needed to elucidate the reason for this association.
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Kilpatrick SE, Abdul-Karim FW, Renner JB, King TS, Klein MJ, Rosenberg AE, Steiner GC, Bullough PG, Schiller AL, Dorfman HD. Interobserver Variability Among Expert Orthopedic Pathologists for Diagnosis, Histologic Grade, and Determination of the Necessity for Chemotherapy in Osteosarcoma. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/15513810009168644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sireci AN, Crapanzano JP, Mansukhani M, Wright T, Babiac A, Erroll M, Vazquez M, Saqi A. Atypical glandular cells (AGC): ThinPrep Imaging System (TIS), manual screening (MS), and correlation with Hybrid Capture 2 (HC2) HPV DNA testing. Diagn Cytopathol 2009; 38:705-9. [PMID: 20014311 DOI: 10.1002/dc.21273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The aim of the study was to determine if the ThinPrep Imaging System (T1S) improves the positive predictive value (PPV) of atypical glandular cell (AGC) diagnosis for identifying HPV-related squamous and/or glandular lesions over manual screening (MS), and if human papilloma virus (HPV)-DNA testing improves the diagnostic yield. MATERIALS AND METHODS 85 ThinPrep cervical cytology specimens with a diagnosis of AGC by TIS (n = 51) and MS (n = 34) were retrieved. The diagnoses were correlated with corresponding histologic follow-up and high risk (HR)-HPV testing results. RESULTS The PPV of AGC by TIS and MS for HPV-related squamous lesions were similar. In the MS group, more cases of glandular pathology were identified, however only three represented adenocarcinoma in-situ (AIS), and the remaining ten were endometrial carcinomas (EMCA). CONCLUSIONS TIS and MS are comparable in the detection of AGC representing squamous histology and the addition of HPV DNA testing does not differentially improve performance. Although the MS group harbored more glandular pathology, the differences in the detection of AIS were not statistically significant.
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Affiliation(s)
- Anthony N Sireci
- Department of Pathology and Cell Biology, New York Presbyterian Hospital, Columbia University Medical Center, New York 10032, USA
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Zhao C, Florea A, Onisko A, Austin RM. Histologic follow-up results in 662 patients with Pap test findings of atypical glandular cells: results from a large academic womens hospital laboratory employing sensitive screening methods. Gynecol Oncol 2009; 114:383-9. [PMID: 19501894 DOI: 10.1016/j.ygyno.2009.05.019] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 05/08/2009] [Accepted: 05/09/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Atypical glandular cell (AGC) Pap interpretations and screening for glandular neoplasias remain major challenges. We document the largest reported AGC histopathologic follow-up experience and include verification bias-adjusted data on laboratory screening sensitivity. METHODS AGC Pap tests of endocervical origin (AGC-EC), endometrial origin (AGC-EM), and not otherwise specified (AGC-NOS) were documented at a center serving an older low risk population. 98% of Pap tests were liquid-based cytology (LBC) specimens screened using computer-assisted screening. Follow-up diagnoses were correlated with cytology and stratified into age groups. Screening sensitivity was assessed by examining Pap results during 1 year preceding neoplastic diagnoses. Verification bias was adjusted with findings in over 2000 patients with hysterectomies. RESULTS Of 247,131 Pap tests, 1021 (0.41%) reported AGC results and 662 cases had tissue follow-up. Precancerous or malignant neoplastic histologic outcomes were documented in 101 patients (15.3%), including 8.3% cervical, 6.3% endometrial, and 0.6% ovarian. AGC results were most often associated with neoplastic cervical outcomes in women younger than 40 and with neoplastic endometrial outcomes in women 50 or older. AGC-NOS with a squamous cell abnormality and AGC-EC results suggested cervical neoplasia, while AGC-EM results suggested endometrial neoplasia. CONCLUSIONS AGC Pap results detected significant numbers of cervical and non-cervical neoplasias. Since 38 of 44 (86%) of AGC-detected carcinomas were endometrial or ovarian, HPV co-testing would not have aided screening in detecting the majority of malignancies diagnosed after AGC Pap results. Verification bias-adjusted Pap screening sensitivity in the laboratory for detection of significant neoplastic cervical disease was 93%.
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Affiliation(s)
- Chengquan Zhao
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213-3180, USA.
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Assessment of reflex human papillomavirus DNA testing in patients with atypical endocervical cells on cervical cytology. Cancer 2008; 114:236-41. [DOI: 10.1002/cncr.23639] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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19
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Chichareon SB, Tocharoenvanich S. Risk factors of having high-grade cervical intraepithelial neoplasia/invasive carcinoma in women with atypical glandular cells of undetermined significance smears. Int J Gynecol Cancer 2006; 16:568-74. [PMID: 16681727 DOI: 10.1111/j.1525-1438.2006.00392.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The objective of this study was to find the risk factors of having high-grade cervical intraepithelial neoplasia/invasive carcinoma in women with atypical glandular cells of undetermined significance (AGUS) smears. A retrospective study of the women with AGUS smears during the 3-year period was performed to determine the correlation between the suspected variables and the histopathologic diagnoses. Among 44,071 smears performed, 119 (0.27%) smears were reported as AGUS. Colposcopies were performed in 102 (88.7%) cases, and high-grade cervical intraepithelial neoplasia/invasive carcinoma was found in 18 (17.6%) cases. Among the following variables, which included age, menopausal status, hormonal contraception, history of previous Pap smears, medical diseases, clinical symptoms, and subclassification of AGUS, both hormonal contraception and AGUS favor neoplasia were risk factors with an odds ratio of 5.4 and 5.0, respectively. Although clinical symptoms seemed to be a significant variable in univariate analysis, it appeared as a confounding factor in multivariate analysis.
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Affiliation(s)
- S B Chichareon
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand.
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Daniel A, Barreth D, Schepansky A, Johnson G, Capstick V, Faught W. Histologic and clinical significance of atypical glandular cells on pap smears. Int J Gynaecol Obstet 2005; 91:238-42. [PMID: 16202416 DOI: 10.1016/j.ijgo.2005.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Revised: 08/11/2005] [Accepted: 08/24/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the association between atypical glandular cells (AGC) on Pap smear and clinically significant histology, in a large health region. METHODS A cytologic database of over one million Pap smears was reviewed for a result of AGUS/AGC. Cytologic and histologic follow up was obtained to establish the presence of significant histology. RESULTS 456 patients available for follow up had AGUS/AGC cytology results (0.043% of all Pap smear results). 197(45.2%) patients had a clinically significant diagnosis including 40 with adenocarcinoma in situ (AIS) of the cervix and 48 with endometrial cancer. CONCLUSION AGC on a Pap smear is frequently associated with a clinically significant diagnosis.
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Affiliation(s)
- A Daniel
- Department of Obstetrics and Gynecology, University of Alberta, Canada
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Raab SS, Grzybicki DM, Zarbo RJ, Meier FA, Geyer SJ, Jensen C. Anatomic Pathology Databases and Patient Safety. Arch Pathol Lab Med 2005; 129:1246-51. [PMID: 16196512 DOI: 10.5858/2005-129-1246-apdaps] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—The utility of anatomic pathology discrepancies has not been rigorously studied.
Objective.—To outline how databases may be used to study anatomic pathology patient safety.
Design.—The Agency for Healthcare Research and Quality funded the creation of a national anatomic pathology errors database to establish benchmarks for error frequency. The database is used to track more frequent errors and errors that result in more serious harm, in order to design quality improvement interventions intended to reduce these types of errors. In the first year of funding, 4 institutions (University of Pittsburgh, Henry Ford Hospital, University of Iowa, and Western Pennsylvania Hospital) reported cytologic-histologic correlation error data after standardizing correlation methods. Root cause analysis was performed to determine sources of error, and error reduction plans were implemented.
Participants.—Four institutions self-reported anatomic pathology error data.
Main Outcome Measures.—Frequency of cytologic-histologic correlation error, case type, cause of error (sampling or interpretation), and effect of error on patient outcome (ie, no harm, near miss, and harm).
Results.—The institutional gynecologic cytologic-histologic correlation error frequency ranged from 0.17% to 0.63%, using the denominator of all Papanicolaou tests. Based on the nongynecologic cytologic-histologic correlation data, the specimen sites with the highest discrepancy frequency (by project site) were lung (ranging from 16.5% to 62.3% of all errors) and urinary bladder (ranging from 4.4% to 25.0%). Most errors detected by the gynecologic cytologic-histologic correlation process were no-harm events (ranging from 10.7% to 43.2% by project site). Root cause analysis identified sources of error on both the clinical and pathology sides of the process, and error intervention programs are currently being implemented to improve patient safety.
Conclusions.—A multi-institutional anatomic pathology error database may be used to benchmark practices and target specific high-frequency errors or errors with high clinical impact. These error reduction programs have national import.
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Affiliation(s)
- Stephen S Raab
- Department of Pathology and Laboratory Medicine, University of Pittsburgh Medical Center/Shadyside, Pittsburgh, PA 15232, USA.
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22
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Oliveira ERZM, Derchain SFM, Rabelo-Santos SH, Westin MCA, Zeferino LC, Campos EA, Syrjanen KJ. Detection of high-risk human papillomavirus (HPV) DNA by Hybrid Capture II in women referred due to atypical glandular cells in the primary screening. Diagn Cytopathol 2005; 31:19-22. [PMID: 15236259 DOI: 10.1002/dc.20049] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We assessed the detection of high-risk human papillomavirus DNA (HPV-DNA) in women examined by a second Pap smear due to atypical glandular cells (AGC) detected in their screening Pap smear. In 91 women included in the study, a second Pap smear was taken and HPV-DNA test was performed using Hybrid Capture II (HC II). The second Pap smear showed no abnormalities in 28 (31%) cases, ACG in 17 (19%) cases, and high-grade squamous intraepithelial lesions (HSIL) or worse in 24 (26%). HC II test was positive in 36% of the cases. Considering the second Pap smear diagnosis, HPV-DNA was detected in 87% of the women with HSIL, 100% of women with in situ adenocarcinoma, and only in 11% of the women with no abnormalities. The use of the second Pap smear combined with HPV-DNA may improve the management of women with AGC in the primary screening.
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Affiliation(s)
- Eliane R Z M Oliveira
- Department of Obstetrics and Gynecology Universidade Estadual de Campinas, Campinas, SP, Brazil
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23
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Abstract
A considerable void exists in the information available regarding anatomic pathology diagnostic errors and their impact on clinical outcomes. To fill this void and improve patient safety, four institutional pathology departments (University of Pittsburgh, Western Pennsylvania Hospital, University of Iowa Hospitals and Clinics, and Henry Ford Hospital System) have proposed the development of a voluntary, Web-based, multi-institutional database for the collection and analysis of diagnostic errors. These institutions intend to use these data proactively to implement internal changes in pathology practice and to measure the effect of such changes on errors and clinical outcomes. They believe that the successful implementation of this project will result in the study of other types of diagnostic pathology error and the expansion to national participation. The project will involve the collection of multi-institutional anatomic pathology diagnostic errors in a large database that will facilitate a more detailed analysis of these errors, including their effect on patient outcomes. Participating institutions will perform root cause analysis for diagnostic errors and plan and execute appropriate process changes aimed at error reduction. The success of these interventions will be tracked through analysis of postintervention error data collected in the database. Based on their preliminary studies, these institutions proposed the following specific aims: Specific aim #1: To use a Web-based database to collect diagnostic errors detected by cytologic histologic correlation and by second-pathologist review of conference cases. Specific aim #2: To analyze the collected error data quantitatively and generate quality performance reports that are useful for institutional quality improvement programs. Specific aim #3: To plan and implement interventions to reduce errors and improve clinical outcomes, based on information derived from root cause analysis of diagnostic errors. Specific aim #4: To assess the success of implemented interventions by quantitative measure of postinterventional errors and clinical outcomes and by qualitative assessment by project participants. Funding for this project was approved by the Agency for Health Care Research and Quality in September 2002, and data collection and analysis are ongoing. Over 5000 errors have been collected in the database, and the clinical outcomes of these errors have been tracked. At a national meeting in November 2003, root cause analysis was performed to determine causes of errors. The findings of these root cause analyses have been presented at national pathology meetings and are currently being published.
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Affiliation(s)
- Stephen S Raab
- Center for Pathology Quality & Healthcare Research, University of Pittsburgh Medical Center/Shadyside, Cancer Pavilion, Room 306, 5150 Centre Avenue, Pittsburgh, PA 15232, USA.
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Abstract
The majority of early lesions, even when centrally located, is missed by conventional white-light (WL) bronchoscopy. Fluorescent bronchoscopy is a promising tool in localising early malignant changes in the central airways, because it is significantly more sensitive than WL bronchoscopy. Originally, drug-induced fluorescence has been used, but today autofluorescence bronchoscopy is more common in relation to its simplicity and advantages. Different systems are available which yield comparable results. However, there are no studies comparing all systems. The disadvantage is the low specificity of the method. Fluorescent bronchoscopy will be more effective if carried out in high-risk patients and/or embedded in a program of preprocedural evaluation of sputum and together with a CT examination of the thorax. But a reduction of mortality as a result of such efforts has not been shown until the present time.
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Affiliation(s)
- Franz Stanzel
- Asklepios Fachkliniken Munich-Gauting, Clinic for Pneumology, Robert-Koch-Allee 2, D-82131 Gauting, Germany.
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Scheiden R, Wagener C, Knolle U, Dippel W, Capesius C. Atypical glandular cells in conventional cervical smears: incidence and follow-up. BMC Cancer 2004; 4:37. [PMID: 15257755 PMCID: PMC497043 DOI: 10.1186/1471-2407-4-37] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2004] [Accepted: 07/19/2004] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atypical glandular cells on cervical smears are often associated with clinically significant uterine lesions. The frequency and accuracy of AGC-NOS (i.e. atypical glandular cells, not otherwise specified) diagnoses, regardless of the gland cell type or the degree of suspicion, and their outcome were investigated. METHODS From January 1, 1990 to December 31, 1999 a total of 261 patients had an AGC-NOS diagnosis made by conventional cervical Papanicolaou smear interpretation representing 0.05% of all Pap-smears analyzed at the national level. 191 (73.2%) patients had a subsequent histological examination, 8 samples were not representative by origin and were excluded. RESULTS Out of 183 AGC-NOS diagnosed, 56.3% (103/183) were associated with tissue-proven precancerous and/or cancerous lesions, 44% being of endocervical and 56% of endometrial origin. 75% of all AGC-patients were asymptomatic. 66.7% (6/9) of the patients with subsequent invasive endocervical adenocarcinoma (AC) and 56% (28/50) of those patients with invasive endometrial AC were without clinical symptoms. 3 patients out of 9 with an invasive endocervical AC were 35 years of age or less. 10.1% and 12.3% of all 'new' tissue-proven invasive endocervical or endometrial AC respectively recorded by the national Morphologic Tumour Registry (MTR) were first identified by a cytological AGC-NOS diagnosis. CONCLUSION Our findings emphasize the importance of the cytological AGC-category even in the absence of a precise origin or cell type specification. 56% of the AGC-diagnoses being associated with significant cancerous or precancerous conditions, a complete and careful evaluation is required.
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Affiliation(s)
- René Scheiden
- Division of clinical cytology, National Health Laboratory, L – 1950 Luxembourg
- Division of pathology, National Health Laboratory, L – 1950 Luxembourg
- Morphologic Tumour Registry, L – 1950 Luxembourg
| | - Catherine Wagener
- Division of clinical cytology, National Health Laboratory, L – 1950 Luxembourg
| | - Ulrich Knolle
- Division of clinical cytology, National Health Laboratory, L – 1950 Luxembourg
| | - Walter Dippel
- Division of pathology, National Health Laboratory, L – 1950 Luxembourg
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Renshaw AA, Mody DR, Lozano RL, Volk EE, Walsh MK, Davey DD, Birdsong GG. Detection of Adenocarcinoma In Situ of the Cervix in Papanicolaou Tests: Comparison of Diagnostic Accuracy With Other High-Grade Lesions. Arch Pathol Lab Med 2004; 128:153-7. [PMID: 14736290 DOI: 10.5858/2004-128-153-doaiso] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Adenocarcinoma in situ of the cervix is a recently recognized interpretation in the Bethesda 2001 system. Although specific morphologic criteria have been published, recognizing this entity is still difficult.
Objective.—To compare pathologists' ability to correctly identify and categorize adenocarcinoma in situ with their ability to identify and categorize adenocarcinoma, high-grade squamous intraepithelial lesion, and squamous cell carcinoma.
Design.—Pathologists' reviews in the 2001 and 2002 College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology Program, an interlaboratory comparison program for gynecologic cytology, were examined. Cases were usually reviewed by multiple pathologists. False-negative rates, the percentage of reviews with exact agreement with reference interpretations, and the percentage of cases in which all reviews were in exact agreement with the reference interpretation for adenocarcinoma in situ, adenocarcinoma, high-grade squamous intraepithelial lesion, and squamous cell carcinoma were compared.
Results.—A total of 213 reviews of cases categorized as adenocarcinoma in situ were compared with 2821 reviews of adenocarcinoma, 7535 reviews of high-grade squamous intraepithelial lesion, and 1886 reviews of squamous cell carcinoma. The false-negative rate for adenocarcinoma in situ (11.7%) was significantly higher than that for high-grade squamous intraepithelial lesion (4.6%, P < .001) and squamous cell carcinoma (3.3%, P < .001) but not for adenocarcinoma (8.9%, P = .16). Of all the reviews of adenocarcinoma in situ cases, 46.5% were interpreted specifically as adenocarcinoma in situ, compared to 72.2% of reviews of adenocarcinoma, 73.2% of high-grade squamous intraepithelial lesion, and 75.1% of squamous cell carcinoma. No individual case of adenocarcinoma in situ was always specifically recognized as adenocarcinoma in situ; 26.5% of cases of adenocarcinoma were specifically recognized as such in all reviews. Findings were similar with and without the inclusion of high-grade squamous intraepithelial lesion/carcinoma, not otherwise specified, as an acceptable review interpretation for cases of adenocarcinoma, squamous cell carcinoma, and high-grade squamous intraepithelial lesion.
Conclusion.—These data from expert-referenced and biopsy-proven cases suggest that adenocarcinoma in situ is not as easily recognized or categorized as other serious diagnoses.
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27
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Abstract
The diagnostic category of atypical glandular cells (AGC) in the Bethesda system for the reporting of cervicovaginal cytology has undergone significant modification since its inception in 1988. More than a decade later, this category remains a diagnostic challenge to both clinicians and cytopathologists because of the lack of uniform cytologic criteria, the lack of interobserver agreement in the diagnosis, and the lack of standardized patient management guidelines. This article reviews the current classification of AGC in the Bethesda system, the cytomorphologic features and differential diagnosis, the clinical significance of a diagnosis of AGC, and the clinical management of patients with AGC. This article provides a comprehensive clinicopathologic review of the category of AGC.
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Affiliation(s)
- Joan F Cangiarella
- Department of Pathology, New York University Medical Center, New York, New York 10016, USA
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Simsir A, Hwang S, Cangiarella J, Elgert P, Levine P, Sheffield MV, Roberson J, Talley L, Chhieng DC. Glandular cell atypia on Papanicolaou smears. Cancer 2003; 99:323-30. [PMID: 14681938 DOI: 10.1002/cncr.11826] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The 2001 Bethesda System recommended qualification of atypical glandular cells (AGC) to indicate the site of origin and separated endocervical adenocarcinoma in situ (AIS) from "AGC favor neoplastic" as a specific diagnostic category. To the authors' knowledge, the literature evaluating the reproducibility of Papanicolaou (Pap) smear diagnosis of glandular cell abnormalities with emphasis on the cell of origin is limited. The aim of the current study was to investigate whether a variety of benign to neoplastic glandular lesions can be reliably classified on Pap smear with regard to diagnosis and cell of origin. METHODS Twenty-three conventional Pap smears (CPS) with glandular cellular changes varying from benign to adenocarcinoma (ACA) were reviewed by six observers. They were asked to categorize each smear according to cell of origin (endocervical vs. endometrial) and diagnosis (benign, AGC, or ACA). Kappa statistics were used to evaluate interobserver agreement and correlation of interobserver agreement with experience. RESULTS There was no consensus among observers for both the origin of the cells and the diagnosis. Interobserver agreement for site was poor (kappa < 0.4) especially in the AGC category. Unanimous agreement for site was reached for 7 of 23 smears (30%). Two of five endocervical AIS were classified as endometrial and another two were classified as benign by four observers. Interobserver agreement was poor in all diagnostic categories (kappa < 0.4) and showed slight correlation with level of experience. Unanimous agreement for diagnosis was reached for only 2 smears (9%). Three of 11 (27%) smears demonstrating preneoplastic/neoplastic processes were diagnosed as benign by 3 observers. Three (25%) benign CPS were diagnosed as ACA by 2 observers. Accurate prediction of the final histologic diagnosis by observers varied from 30% to 87% and did not correlate closely with experience. CONCLUSIONS Cytologic diagnosis of glandular lesions by CPS was problematic and suffered from significant interobserver subjectivity.
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Affiliation(s)
- Aylin Simsir
- Division of Cytopathology, Department of Pathology, New York University Medical Center, New York, New York 10016, USA.
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29
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Abstract
The 2001 Bethesda System has radically altered the classification of glandular abnormalities. The recognition of the cytologic features of atypical glandular cells on cervicovaginal smears is important because a significant number of patients will be found to have an underlying cancerous or dysplastic lesion of the exocervix, endocervix, or endometrium. The differential diagnosis of AGC on cytology is diverse and accurate classification is necessary because the most appropriate form of follow-up depends on the specific subcategorization of the atypical glandular cells. Because the level of interobserver agreement in the diagnosis of AGC is poor, effective communication between cytopathologists and clinicians is essential to accurately triage these patients. This article should help the cytology practitioner by providing a comprehensive review of the approach to the interpretation, clinical significance, histopathologic correlation, and management of patients who have atypical glandular cells on gynecologic cytology specimens.
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Affiliation(s)
- David C Chhieng
- Department of Pathology, University of Alabama at Birmingham, 619 19th Street South, KB 627, Birmingham, AL 35249-6823, USA.
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Stelow EB, Skeate R, Wahi MM, Kjeldahl K, McKeon D, Larkin S, Woronzoff K, Pambuccian SE. Pap test discrepancies and follow-up histology. Diagn Cytopathol 2003; 29:111-5. [PMID: 12889052 DOI: 10.1002/dc.10332] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Papanicolaou (Pap) test discrepancy rates between cytotechnologists (CTs) and cytopathologists (CPs) are often kept to evaluate the performance of individual CTs. This is based on the unproven assumption that the CP's diagnoses are more likely to be correct. We investigated this assumption using data from our discrepancy files and comparing them to follow-up histology. All Pap test discrepancies were noted between January 1, 2001-December 31, 2001. Surgical pathology files were then searched for follow-up histology within 9 mo of the Pap test. Histologic diagnoses were compared with the previous CT and CP diagnoses, and then judged regarding accuracy. In total, 63,376 Pap tests were evaluated between January 1, 2001-December 31, 2001. There were 795 discrepancies throughout this period (1.25%). One hundred and sixty-six cases with discrepancies had follow-up histology within 9 mo of the Pap test (20.9%). Of downgraded cases (103), CPs were more correct in 51 cases (49.5%), whereas CTs were more correct in 52 cases (50.5%). Of upgraded cases (63), CPs were more correct in 19 cases (30.2%), whereas CTs were more correct in 44 cases (69.8%). Our results suggest that CPs are not more likely to be correct than CTs when there is a discrepancy with the diagnosis of a Pap test, especially when CPs upgrade CT diagnoses. This suggests that discrepancy data may be helpful for evaluating the performance of both CPs and CTs. It may also be of educational use for both CPs and CTs to know the follow-up histology in these cases.
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Affiliation(s)
- Edward B Stelow
- Department of Pathology and Laboratory Medicine, University of Minnesota, Minneapolis, Minnesota 55415, USA.
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Levine L, Lucci JA, Dinh TV. Atypical glandular cells: new Bethesda Terminology and Management Guidelines. Obstet Gynecol Surv 2003; 58:399-406. [PMID: 12775944 DOI: 10.1097/01.ogx.0000070068.74408.f6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although Pap tests have enabled early detection of premalignant lesions, the introduction of new collecting devices has significantly improved the detection of lesions hidden in the endocervical canal, such as adenocarcinoma in situ (AIS). The term "atypical glandular cells of undetermined significance" (AGUS) was introduced at the 1988 Bethesda Conference and defined as morphologic changes in glandular cells beyond those that are suggestive of the benign reactive process, but insufficient for the diagnosis of adenocarcinoma in situ (AIS). In the new 2001 Bethesda System, the term has been eliminated and replaced with the term "atypical glandular cells" (AGC), with the following subclassifications: not otherwise specified (NOS), favor neoplasia, endocervical AIS, and adenocarcinoma. The risks of premalignant or malignant disease associated with the AGC favor neoplasia category are substantially higher than in the AGC NOS category (96% vs. 9-41%, respectively). Patients diagnosed with AGC NOS or AGC favor neoplasia will require colposcopy, endocervical sampling, and, for patients over 35 years of age, endometrial biopsy. If all of these tests are negative, the Pap test should be repeated in 4-6 month intervals until 4 consecutive normal tests are obtained. Positive results in one of the tests will require management according to ASCCP guidelines. The AGC favor neoplasia diagnosis also requires cervical conization and/or other testing, as the incidence of premalignant or malignant lesions in patients with this diagnosis is high. The role of HPV testing in this setting is unknown at this time.
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Affiliation(s)
- Lyuba Levine
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas 77555, USA.
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Segal A, Frost FA, Miranda A, Fletcher C, Sterrett GF. Predictive value of diagnoses of endocervical glandular abnormalities in cervical smears. Pathology 2003; 35:198-203. [PMID: 14506961 DOI: 10.1080/0031302031000123146] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIMS To determine the positive predictive value (PPV) of cervical smear diagnoses of 'definite' and 'possible' endocervical adenocarcinoma in situ or invasive adenocarcinoma, and whether diagnostic accuracy can be improved. METHODS The study examined cervical smears reported as definite or possible high-grade glandular abnormality between 1992 and 1998. PPV was calculated by comparing smear diagnoses with the subsequent histopathology report. All available smears were reviewed without knowledge of follow-up results, and were reclassified by consensus. RESULTS Thirty-two smears were diagnosed as high-grade glandular lesions, with adequate biopsy follow-up in 31 cases (96.9%). A high-grade epithelial abnormality (HGEA) was detected in 29 cases (PPV, 93.5%), with a high-grade glandular lesion in 24 (PPV, 77.4%). Very few smears were reclassified on review. Seventy-three smears were initially diagnosed in the 'inconclusive' glandular or indeterminate cell-type category. There was adequate biopsy follow up for 54 cases (74.0%). On follow-up, 31 cases had a HGEA (PPV, 57.4%), with 14 cases having a high-grade glandular abnormality (PPV, 25.9%). In the review of 'inconclusive' smears, 12 were reclassified as squamous abnormalities and none of these had a glandular lesion on biopsy. Eight were reclassified as negative; seven contained endometrial stroma and the glandular cells in question were considered to be of lower uterine segment (LUS) origin. No significant lesion was present on follow-up of these cases. CONCLUSIONS For clinicians using our laboratory, large loop excision of the transformation zone (LLETZ) or cone biopsy should follow a 'definite' cytological diagnosis of a high-grade endocervical glandular lesion. However, cone biopsy may not be the appropriate initial management in the 'possible' high-grade glandular group because of a significantly lower predictive value of the diagnosis. The slide review highlighted the importance of (1) caution in classifying sheets of abnormal cells as glandular, and (2) endometrial stroma as a marker of LUS material.
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Affiliation(s)
- Amanda Segal
- Division of Tissue Pathology, The Western Australian Centre for Pathology and Medical Research, Nedlands, Western Australia
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Chhieng DC, Talley LI, Roberson J, Gatscha RM, Jhala NC, Elgert PA. Interobserver variability: comparison between liquid-based and conventional preparations in gynecologic cytology. Cancer 2002; 96:67-73. [PMID: 11954023 DOI: 10.1002/cncr.10477] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Studies have shown that the ThinPrep Papanicolaou test (TP) increases the detection of epithelial cell abnormalities compared with the conventional preparation. Little is known about the interobserver variability of reporting gynecologic cytology results using the TP preparation and its comparison with results obtained using the conventional method. METHODS To compare the interobserver variability between the TP method and the conventional method for reporting the diagnoses of gynecologic cytology, 20 pairs of conventional and TP slides (total, 40 slides) that were prepared from split samples were evaluated blindly by 19 cytotechnologists from three different laboratories. Each reviewer was asked to categorize each slide into the following five categories: within normal limits, benign cellular changes, atypical squamous cells of undetermined significance, low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesion (HSIL). For both conventional and TP preparations, interobserver variability was analyzed using Spearman rank correlation coefficients. The mean correlation coefficients (weak, 0.0-0.4; fair, 0.4-0.7; and strong, 0.7-1.0) between the TP method and the conventional method were then compared. RESULTS The overall interobserver agreement as well as interobserver agreement within each laboratory was good for both TP and conventional preparations. Based on the set of conventional cervical smears, only one slide that was diagnosed as HSIL had unanimous agreement; whereas, based on the set of TP slides, three slides, including two diagnosed as HSIL and one diagnosed as LSIL, had a unanimous diagnosis. The difference in the interobserver agreement between TP and conventional methods, based on comparing their mean +/- standard deviation correlation coefficients (TP method, 0.84 +/- 0.081; conventional method, 0.82 +/- 0.105; P < 0.001), was statistically significant. CONCLUSIONS Interobserver agreement in reporting gynecologic cytology using the TP method is good, particularly for squamous intraepithelial lesions, and appears to be superior to the conventional method.
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Affiliation(s)
- David C Chhieng
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama 35249-6823, USA.
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Condel JL, Mahood LK, Grzybicki DM, Sturgis CD, Raab SS. Papanicolaou tests diagnosed as atypical by a cytotechnologist and downgraded to benign by a pathologist: a measure of laboratory quality. Am J Clin Pathol 2002; 117:534-40. [PMID: 11939726 DOI: 10.1309/wvw0-48tj-e7va-dm8r] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Follow-up of Papanicolaou (Pap) tests diagnosed as atypical squamous cells of undetermined significance (ASCUS) or atypical glandular cells of undetermined significance (AGUS) by a cytotechnologist and downgraded to benign by a pathologist has not been measured. Squamous intraepithelial lesion (SIL) follow-up rates were obtained for Pap tests diagnosed as ASCUS (288) or AGUS (94) and downgraded to benign and for Pap tests diagnosed as repair (231). Statistically significant associations were seen between 7 cytotechnologists and between 7 pathologists and ASCUS, AGUS, downgraded ASCUS, and downgraded AGUS rates. The percentage of downgraded ASCUS cases compared with all ASCUS cases per pathologist ranged from 4.8% to 43.7%. Statistically significant associations between pathologists and SIL follow-up rates for downgraded ASCUS diagnoses were seen. The SIL follow-up rate for repair (7.9%) was similar to that for a downgraded ASCUS (11.0%) or AGUS (7.3%). The parameters of downgraded ASCU and AGUS Pap test interpretations are good quality indicators of individual performance and overall laboratory quality.
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Affiliation(s)
- Jennifer L Condel
- Department of Pathology and Laboratory Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, USA
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Nasuti JF, Fleisher SR, Gupta PK. Atypical glandular cells of undetermined significance (AGUS): clinical considerations and cytohistologic correlation. Diagn Cytopathol 2002; 26:186-90. [PMID: 11892026 DOI: 10.1002/dc.10070] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The diagnoses of atypical glandular cells of undetermined significance (AGUS) made upon evaluation of cervical/vaginal (Pap) smears is examined to ascertain salient clinical and cytologic features that may lead to better characterization of the true nature of these lesions. Prior history of squamous dysplasia, age of the patient, and the occurrence of abnormal microbiopsy tissue fragments are investigated to determine their value in the proper evaluation of AGUS specimens. Of the 86,234 Pap smears submitted to our laboratory during a period of 2 yr, 187 (0.2%) were diagnosed as AGUS. Available follow-up in 128 (69%) cases revealed 54 (42%) significant tissue proven abnormalities, the majority (55%, 30 patients) of which were diagnosed as squamous intraepithelial lesions (SIL). Squamous dysplasia is significantly more common in women younger than 40 (15/18, 83%) and in patients with prior history of SIL (29/30, 97%). In addition, all nine patients diagnosed with endometrial lesions on subsequent histology were older than 40. Age, however, was not a discriminating factor in women proven to have endocervical glandular lesions. Additionally, certain tissue fragment cytomorphologic features were significantly more often observed on follow-up in specific histologic diagnostic categories. The Pap smears of patients diagnosed with SIL were noted to contain tissue fragments composed of both dysplastic squamous and benign glandular cells in 29 of 30 (97%). The presence of two distinct populations of glandular tissue fragments (typical and atypical) was found in the Pap smears of all nine women with endometrial abnormalities and in the smears of most women subsequently diagnosed with endocervical glandular lesions (87%, 13/15). These observations suggest that a more specific and clinically useful Pap smear interpretation other than AGUS is often possible by consideration of the patient's age and prior history along with the correct identification of the type of atypical cells observed in abnormal tissue fragments.
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Affiliation(s)
- Joseph F Nasuti
- University of Pennsylvania Medical Center, Department of Pathology and Laboratory Medicine, Cytopathology and Cytometry Section, 3400 Spruce Street/6 Founders Pavilion, Philadelphia, PA 19104, USA.
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Lee KR, Darragh TM, Joste NE, Krane JF, Sherman ME, Hurley LB, Allred EM, Manos MM. Atypical glandular cells of undetermined significance (AGUS): Interobserver reproducibility in cervical smears and corresponding thin-layer preparations. Am J Clin Pathol 2002; 117:96-102. [PMID: 11789738 DOI: 10.1309/hl0b-c7y6-ac77-nd2u] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Five panelists independently reviewed 135 consecutive conventional cervical smears (CPs) originally classified as atypical glandular cells of undetermined significance (AGUS). A thin-layer slide (TP), prepared from the residual material, also was reviewed in each case. All patients underwent colposcopy that yielded at least 1 histologic specimen. Three or more of 5 reviewers retained the AGUS interpretation for 29% of CPs and 12% of the corresponding TPs. Interobserver variability infrequency of use of AGUS was marked, and interobserver agreement was poor. Agreement was improved for cases cytologically interpreted as a high-grade lesion, especially in TPs. Four of 5 reviewers retained the AGUS classification in CPs for all 7 biopsy-proven neoplastic glandular lesions. Of 95 CP interpretations made by 5 reviewers in the 19 histologically diagnosed high-grade lesions, 8 were "negative/reactive" and 6 were AGUS "favor reactive." AGUS is a poorly reproducible cytologic interpretation. Although most neoplastic glandular lesions may be distinguished by cytopathologists experienced in this area from mimics originally considered AGUS, attempts to increase the diagnostic specificity of AGUS may diminish sensitivity for an underlying high-grade precursor. Interobserver agreement was better for TPs than for the corresponding CPs. However, the split-sample TP slides may not have been fully comparable to the CPs.
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Affiliation(s)
- Kenneth R Lee
- Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA
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Grzybicki DM, Liu Y, Moore SA, Brown HG, Silverman JF, D'Amico F, Raab SS. Interobserver variability associated with the MIB-1 labeling index: high levels suggest limited prognostic usefulness for patients with primary brain tumors. Cancer 2001; 92:2720-6. [PMID: 11745208 DOI: 10.1002/1097-0142(20011115)92:10<2720::aid-cncr1626>3.0.co;2-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The use of the MIB-1 labeling index (LI) as a potential prognostic marker for patients with primary brain tumors is controversial. Many studies advocating its prognostic usefulness have suggested discrete MIB-1 LI cut-off values, above which patients have significantly worse outcomes. However, interobserver variability associated previously with MIB-1 LI calculation has not been reported despite the fact that the degree of interobserver variability impacts the clinical usefulness of such cut-off values. METHODS MIB-1 LIs were calculated independently using a standardized protocol by six pathologist observers for 50 astrocytic gliomas of varying grades. The level of interobserver agreement was determined by calculating kappa statistics for pairwise pathologist comparisons using MIB-1 LI cut-off values of 2.5%, 5.0%, 8.0%, 11.0%, and 15.0%. Spearman rank correlation coefficients were used to assess the pairwise associations between observer MIB-1 LIs. RESULTS Although there was general agreement among pathologists regarding whether an MIB-1 LI for a given astroglial tumor was low, moderate, or high based on the analysis of correlation, a high level of interobserver variability was associated with the determination of specific MIB-1 LIs. The highest level of agreement occurred using a cut-off value of 5.0%, with pairwise kappa statistics for this value ranging from 0.52 to 0.80. CONCLUSIONS The high level of interobserver variability suggests that proposed discrete MIB-1 LI prognostic cut-off values most likely are not useful clinically for predicting outcome for individual patients with primary brain tumors. Further prospective studies are needed investigating the prognostic usefulness of MIB-1 LI ranges that optimize interobserver agreement.
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Affiliation(s)
- D M Grzybicki
- Department of Pathology and Laboratory Medicine, Allegheny General Hospital and MCP Hahnemann University, Pittsburgh, Pennsylvania 15212, USA.
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Cochand-Priollet B, Le Galès C, de Cremoux P, Molinié V, Sastre-Garau X, Vacher-Lavenu MC, Vielh P, Coste J. Cost-effectiveness of monolayers and human papillomavirus testing compared to that of conventional Papanicolaou smears for cervical cancer screening: protocol of the study of the French Society of Clinical Cytology. Diagn Cytopathol 2001; 24:412-20. [PMID: 11391824 DOI: 10.1002/dc.1091] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The French Society of Clinical Cytology is conducting a study to compare the cost-effectiveness of monolayers and human papillomavirus (HPV) testing with that of conventional Papanicolaou (Pap) smears for cervical cancer screening. The protocol of this study is presented. It includes 3,000 women who will be evaluated by the three methods (conventional Pap smears, or monolayers with or without HPV testing) and by the reference method: colposcopy followed, in cases with abnormalities, by cervical biopsy. Efficacy or performance of the methods will be compared on the basis of sensitivity. Cost comparisons and cost-effectiveness modeling will be based on the costs associated with methods themselves and also the costs of "false positives." This will require specific collection of data concerning the costs of the three methods, as these costs have not previously been accurately documented. Patient recruiting and data collection started in September 1999 and will be complete in June 2000. The first results are expected to be available in spring 2001.
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Affiliation(s)
- B Cochand-Priollet
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Lariboisière, Paris, France.
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Diaz-Rosario LA, Kabawat SE. Cell block preparation by inverted filter sedimentation is useful in the differential diagnosis of atypical glandular cells of undetermined significance in ThinPrep specimens. Cancer 2000. [DOI: 10.1002/1097-0142(20001025)90:5<265::aid-cncr1>3.0.co;2-q] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Austin RM. Follow-up of abnormal gynecologic cytology. A College of American Pathologists Q-Probes Study of 16,312 cases from 306 laboratories. Arch Pathol Lab Med 2000; 124:1113-4. [PMID: 10923066 DOI: 10.5858/2000-124-1113-fuoagc] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Many reports have been published on the accuracy of the cervical vaginal smear for squamous lesions, and the literature contains fewer reports on the accuracy of the cervical vaginal smear for glandular lesions. The sensitivity of glandular lesion diagnosis depends on the subtype of lesion. The diagnostic sensitivity is highest for invasive endocervical adenocarcinoma and lowest for endometrial adenocarcinoma. The ability of some of the Bethesda system categories for glandular lesions to describe what they purport to describe is questionable. The Bethesda system categories of adenocarcinoma accurately classify adenocarcinomas. The Bethesda System category of atypical glandular cells of undetermined significance (AGUS) is a misnomer. Although many cases of adenocarcinoma in-situ are placed in this category, follow-up of patients with AGUS show that the majority of patients with clinically significant lesions have squamous dysplasias. Other categories of AGUS, such as AGUS favor endometrial origin, are more appropriately named and encompass endometrial lesions which are either neoplastic or non-neoplastic.
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Affiliation(s)
- S S Raab
- Department of Pathology, Allegheny General Hospital, Pittsburgh, Pennsylvania, 15212-4772, USA.
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Roberts JM, Thurloe JK, Bowditch RC, Laverty CR. Subdividing atypical glandular cells of undetermined significance according to the Australian modified Bethesda system. Cancer 2000. [DOI: 10.1002/(sici)1097-0142(20000425)90:2<87::aid-cncr3>3.0.co;2-o] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Liao SY, Stanbridge EJ. Expression of MN/CA9 protein in Papanicolaou smears containing atypical glandular cells of undetermined significance is a diagnostic biomarker of cervical dysplasia and neoplasia. Cancer 2000; 88:1108-21. [PMID: 10699902 DOI: 10.1002/(sici)1097-0142(20000301)88:5<1108::aid-cncr23>3.0.co;2-d] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Despite the enormous impact that Papanicolaou (Pap) smear screening has had on the incidence of cervical carcinoma in developed countries, there is still an unacceptably high frequency of occurrence of this cancer. In part, this is due to human error associated with cytologic diagnoses of Pap smears. Also, the use of new sampling devices, such as the cytobrush, has increased the complexity of diagnosing benign and neoplastic cervical cytology. This is particularly apparent in the diagnosis of atypical glandular cells of undetermined significance (AGUS). Approximately 40% of AGUS diagnoses have a corresponding significant lesion at biopsy follow-up, and 60% do not. There is clearly a need for an adjunct to cytologic diagnosis that can readily identify AGUS smears that are diagnostic of significant lesions. The authors have identified the MN/CA9 antigen as a strong candidate for an adjunct biomarker. METHODS A total of 245 Pap smears of all AGUS diagnostic categories with histologic confirmation were studied. The median age of the patients was 39 years. The Bethesda system classification (AGUS-favor reactive, AGUS-not otherwise specified, and AGUS-favor neoplastic) was used. All of the Pap smears were decolorized and immunostained with monoclonal antibody to MN/CA9 antigen by the immunoperoxidase technique. The results of MN/CA9 immunoreactivity were correlated with the histologic data in a semiblinded fashion. RESULTS The follow-up biopsies showed that a high percentage (70%) of patients had low and high grade cervical intraepithelial neoplasia lesions, respectively (CIN I and CIN II or III). Clinically significant lesions-adenocarcinoma in situ/carcinoma (AIS/CA) and CIN II or III-were found in 50% of the cases. Among these, 11% were AIS/CA. In the three subcategories of AGUS diagnosis, the AGUS-not otherwise specified showed the broadest range of lesions in the follow-up biopsies. Three patterns of MN/CA9 immunoreactivity were observed in the Pap smears: 1) atypical cells, 2) normal endocervical cells only, and 3) all cells negative. All Pap smears that were MN/CA9 positive were histologically confirmed to be clinically significant lesions or CIN I; in addition, there were a very small number (n = 12) of cases of atypia. None of the benign lesions showed MN/CA9 expression in the corresponding Pap smears. Furthermore, the pattern of atypical cell immunostaining identified all cases with significant lesions (AIS/CA and CIN II or III) in the cervices. Conversely, the majority of CIN I cases (82%) and all cases of atypia showed positive immunostaining restricted to normal endocervical cells only. CONCLUSIONS There is a clear association between MN/CA9 immunostaining of atypical cells and the presence of significant lesions in the cervix. Similarly, there is a clear association between lack of expression of MN/CA9 and the absence of cervical lesions. However, the screen does not allow discrimination between CIN I and atypia. The authors also found that, based on the combined patterns of morphology and immunostaining, they are able to discriminate between AIS and CIN II or III in AGUS Pap smear diagnoses. Thus, expression of the MN/CA9 antigen is indeed a discriminator of significant lesions in AGUS Pap smear diagnoses.
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Affiliation(s)
- S Y Liao
- Department of Medicine, University of California-Irvine, Irvine, California; Department of Pathology, St. Joseph Hospital, Orange, CA, USA
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Davey DD, Woodhouse S, Styer P, Stastny J, Mody D. Atypical epithelial cells and specimen adequacy: current laboratory practices of participants in the college of American pathologists interlaboratory comparison program in cervicovaginal cytology. Arch Pathol Lab Med 2000; 124:203-11. [PMID: 10656727 DOI: 10.5858/2000-124-0203-aecasa] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The Bethesda System for reporting cervical/vaginal cytologic diagnoses introduced terminology for atypical squamous and glandular cells and categories for specimen adequacy. OBJECTIVES To analyze current laboratory reporting practices and compare trends to previous surveys. DESIGN Questionnaire surveys were mailed to 2000 laboratories in 1996 and 1997. PARTICIPANTS Laboratories enrolled in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology. MAIN OUTCOME MEASURES Laboratory policies, criteria, and reporting rates for Bethesda System categories. RESULTS The 1996 specimen adequacy survey had 1166 respondents, and 768 laboratories returned the 1997 questionnaire focusing on atypical squamous cells of undetermined significance (ASCUS) and glandular cells of undetermined significance (AGUS). Nearly all laboratories (92%) routinely reported specimen adequacy, an increase from the 66% rate in 1991. The median rate for unsatisfactory specimens was 0.5% (mean 0.95%), and the median rate for the satisfactory but limited category was 5.8% (mean 9.3%). The Bethesda criteria for designating a specimen unsatisfactory were used by more than 90% of laboratories. Nearly all laboratories (97%) used the term ASCUS in 1997, and more than 80% of laboratories used the Bethesda criteria for this category. Median reporting rates for epithelial abnormalities were as follows: ASCUS, 4.5%; AGUS, 0.3%; low-grade squamous intraepithelial lesion (SIL), 1.6%; and high-grade SIL, 0.5%. The median ASCUS/SIL ratio was 2.0, with 80% of laboratories reporting ratios between 0.64 and 4.23. The median ASCUS rate and ASCUS/SIL ratio were higher than 1993 survey results. Nearly all laboratories attempted follow-up studies on patients with abnormal cytology results, and midsized laboratories achieved the highest rates of follow-up. Median rates of abnormalities following an ASCUS or AGUS diagnosis were 20% and 15%, respectively. Laboratory respondents commonly used written recommendations in ASCUS/AGUS reports. CONCLUSIONS Most laboratories that responded to the surveys had adopted Bethesda terminology and criteria for specimen adequacy and ASCUS/AGUS. Reporting rates for SIL and adequacy categories have remained stable, but median ASCUS rates and ASCUS/SIL ratios are higher than in 1993. The AGUS category is reported infrequently, but can be associated with significant pathology.
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Affiliation(s)
- D D Davey
- Department of Pathology, University of Kentucky, Lexington, KY, USA
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Burnett AF. Atypical glandular cells of undetermined significance Pap smears: appropriate evaluation and management. Curr Opin Obstet Gynecol 2000; 12:33-7. [PMID: 10752514 DOI: 10.1097/00001703-200002000-00006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This review focuses on atypical glandular cells of undetermined significance Pap smears, with attention given to the classifications of atypical glandular cells of undetermined significance, the clinical and histopathologic correlation, and recent advances in triage strategies for this entity. The management of atypical glandular cells of undetermined significance Pap smears will emphasize the significance of this finding in terms of diagnosing dysplasia and carcinoma of the lower female genital tract.
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Affiliation(s)
- A F Burnett
- Alexander F. Burnett MD, Division of Gynecologic Oncology, University of Southern California, Women's and Children's Hospital, Los Angeles 90033, USA.
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Raab SS, Bishop NS, Zaleski MS. Effect of cervical disease history on outcomes of women who have a pap diagnosis of atypical glandular cells of undetermined significance. Gynecol Oncol 1999; 74:460-4. [PMID: 10479510 DOI: 10.1006/gyno.1999.5512] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the relationship between history of cervical dysplasia or carcinoma and the development of cervical dysplasia or adenocarcinoma in women who have a diagnosis of atypical glandular cells of undetermined significance (AGUS), favor endocervical origin, or AGUS, not otherwise specified. METHODS A 6-year retrospective review of the pathology files was performed for 93 women who were diagnosed in 1992 with AGUS, favor endocervical origin, or AGUS, not otherwise specified. Data collected included previous history of cervical disease, follow-up diagnoses, time interval between follow-ups, and procedures performed. RESULTS Of women with follow-up who had or did not have a previous history of cervical dysplasia, 32.0 and 12.0%, respectively, developed a squamous dysplasia or adenocarcinoma in situ. This difference was statistically significant (P<0.05). Of the women who had or did not have a previous history of cervical dysplasia and had Pap smear follow-up, only 4.2 and 4.3%, respectively, had a false-negative diagnosis on the most immediate subsequent smear. CONCLUSIONS Women who have AGUS, favor endocervical origin, or AGUS, not otherwise specified, and no history of cervical dysplasia have a significantly lower risk of developing or having cervical dysplasia than women who have the same diagnosis and a history of cervical dysplasia. This may warrant different treatment protocols for these two groups. For the women with AGUS and no previous history of cervical dysplasia, a repeat Pap smear, rather than colposcopy with curettage, may be warranted.
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Affiliation(s)
- S S Raab
- Department of Pathology and Laboratory Medicine, Division of Clinical Effectiveness and Outcomes Research, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, Pennsylvania 15212, USA.
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