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Mehta SP, Patel TS, Jana T, Samanta ST, Malvania R, Trivedi PP, Girdher S. How useful are cervical Pap smears in detecting endometrial carcinomas? A tertiary cancer center experience. Diagn Cytopathol 2020; 49:127-131. [PMID: 32910561 DOI: 10.1002/dc.24609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/13/2020] [Accepted: 08/25/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the role of routine cervical Pap smears in detecting endometrial carcinomas. METHOD A retrospective study was carried out from the histopathology archives for cases diagnosed as endometrial carcinomas with Pap smears within 6 months before histological diagnosis. The demographic details, reports of Pap smears and other tumor parameters on histopathology were noted. RESULTS We identified 380 of 482 cases of endometrial carcinoma with a documented Pap smear within 6 months before histopathogical diagnosis. Out of 380 cases, 187 cases (49.2%) had shown abnormalities on Pap smear of which 80 cases (42%) were diagnosed as atypical glandular cells and 78 cases (41.7%) were diagnosed as adenocarcinoma. The presence of glandular abnormality on Pap smear significantly correlated with the tumor type, myometrial invasion and cervical involvement on histopathology (P < .05). Cases which had higher FIGO staging also had a higher detection rate on Pap smear (P < .05). CONCLUSION The Pap smear may help in detection of endometrial carcinoma especially in cases with type 2 endometrial carinomas, tumor with cervical involvement and/or advanced FIGO stage.
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Affiliation(s)
- Shailee P Mehta
- Department of Oncopathology, Gujarat Cancer And Research Institute, Ahmedabad, Gujarat, India
| | - Trupti S Patel
- Department of Oncopathology, Gujarat Cancer And Research Institute, Ahmedabad, Gujarat, India
| | - Torsha Jana
- Department of Oncopathology, Gujarat Cancer And Research Institute, Ahmedabad, Gujarat, India
| | - Satarupa T Samanta
- Department of Oncopathology, Gujarat Cancer And Research Institute, Ahmedabad, Gujarat, India
| | - Rujuta Malvania
- Department of Oncopathology, Gujarat Cancer And Research Institute, Ahmedabad, Gujarat, India
| | - Priti P Trivedi
- Department of Oncopathology, Gujarat Cancer And Research Institute, Ahmedabad, Gujarat, India
| | - Swati Girdher
- Department of Oncopathology, Gujarat Cancer And Research Institute, Ahmedabad, Gujarat, India
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2
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Frias-Gomez J, Benavente Y, Ponce J, Brunet J, Ibáñez R, Peremiquel-Trillas P, Baixeras N, Zanca A, Piulats JM, Aytés Á, Matias-Guiu X, Bosch FX, de Sanjosé S, Alemany L, Costas L. Sensitivity of cervico-vaginal cytology in endometrial carcinoma: A systematic review and meta-analysis. Cancer Cytopathol 2020; 128:792-802. [PMID: 32202704 DOI: 10.1002/cncy.22266] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 12/24/2022]
Abstract
Cervico-vaginal cytology is primarily a cervical cancer screening test. The anatomical continuity of the uterine cavity with the cervix makes the Papanicolaou (Pap) test accessible to evaluate signs of disease shed from the endometrium. Our aim was to determine the sensitivity of routine Pap test in endometrial carcinoma detection and its relationship with clinico-pathologic factors. We performed a systematic review of studies reporting Pap test results prior to diagnosis of or surgery for endometrial carcinoma between 1990 and 2018 in PubMed or Web of Science. Two independent reviewers extracted data and assessed study quality using an adapted Newcastle-Ottawa Quality Assessment Scale and Quality Assessment of Diagnostic Accuracy Studies tool. We identified 45 studies including a total of 6599 women with endometrial cancer. Abnormal Pap test results prior to diagnosis of or surgery for endometrial carcinoma were observed in 45% (95% CI, 40%-50%) of study participants. This percentage was significantly higher among those of non-endometrioid histology compared with endometrioid subtypes (77% [95% CI, 66%-87%] vs 44% [95% CI, 34%-53%], respectively; P heterogeneity <.001). Several clinico-pathologic factors were related to a higher percentage of abnormal Pap test results, including high-stage, myometrial invasion >50%, high histological grade, positive peritoneal cytology, presence of lymph node metastasis, cervical involvement, and lymphovascular invasion (P heterogeneity <.05 for all variables). Routine cervical cytology can detect endometrial cancer in almost half of patients, whereas sensitivity is higher among individuals with non-endometrioid histology or more advanced cancers. This review summarizes the current clinical and prognostic value of cervical cytology in endometrial carcinoma. Recent technological developments using molecular biomarkers may improve accuracy for early cancer detection.
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Affiliation(s)
- Jon Frias-Gomez
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Yolanda Benavente
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain
| | - Jordi Ponce
- Department of Gynecology and Obstetrics, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Brunet
- Hereditary Cancer Program, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Cáncer, Madrid, Spain.,Medical Sciences Department, School of Medicine, University of Girona, Girona, Spain
| | - Raquel Ibáñez
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Paula Peremiquel-Trillas
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Nuria Baixeras
- Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Alba Zanca
- Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Maria Piulats
- Centro de Investigación Biomédica en Red en Cáncer, Madrid, Spain.,Department of Medical Oncology, IDIBELL, Catalan Institute of Cancer, Hospitalet de Llobregat, Barcelona, Spain
| | - Álvaro Aytés
- Program Against Cancer Therapeutic Resistance, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Matias-Guiu
- Centro de Investigación Biomédica en Red en Cáncer, Madrid, Spain.,Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Francesc Xavier Bosch
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Silvia de Sanjosé
- Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.,PATH, Seattle, Washington
| | - Laia Alemany
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain
| | - Laura Costas
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
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3
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Effectiveness of Pap Smears as Predictor in the Diagnosis of Carcinoma Endometrium at a Tertiary Oncology Centre in India. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-020-0380-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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4
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Vicari M, Guidobaldi L, Perrella E, Bianchi A, Ferrari S, Martucci M, Petitti T, Rabitti C, Crescenzi A. Morphometric analysis of atypical glandular cells correctly classifies normal, reactive, and atypical cells in cervical smears. Diagn Cytopathol 2019; 48:10-16. [DOI: 10.1002/dc.24320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/29/2019] [Accepted: 09/06/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Marco Vicari
- Pathology UnitUniversity Hospital Campus Bio‐Medico of Rome Rome Italy
| | - Leo Guidobaldi
- Cytodiagnostic Service, Microbiology and Virology Unit“Sandro Pertini” Hospital Rome Italy
| | - Eleonora Perrella
- Pathology UnitUniversity Hospital Campus Bio‐Medico of Rome Rome Italy
| | - Antonella Bianchi
- Pathology UnitUniversity Hospital Campus Bio‐Medico of Rome Rome Italy
| | - Simona Ferrari
- Pathology UnitUniversity Hospital Campus Bio‐Medico of Rome Rome Italy
| | | | - Tommasangelo Petitti
- Hygiene, Public Health and statistics Research UnitCampus Bio‐Medico University Rome Italy
| | - Carla Rabitti
- Pathology UnitUniversity Hospital Campus Bio‐Medico of Rome Rome Italy
| | - Anna Crescenzi
- Pathology UnitUniversity Hospital Campus Bio‐Medico of Rome Rome Italy
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5
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Glandular cell abnormalities in cervical cytology: What has changed in this decade and what has not? Eur J Obstet Gynecol Reprod Biol 2019; 240:68-73. [DOI: 10.1016/j.ejogrb.2019.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/04/2019] [Accepted: 06/09/2019] [Indexed: 11/22/2022]
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6
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Kamineni V, Nair P, Deshpande A. Can LBC Completely Replace Conventional Pap Smear in Developing Countries. J Obstet Gynaecol India 2019; 69:69-76. [PMID: 30814813 DOI: 10.1007/s13224-018-1123-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 04/16/2018] [Indexed: 10/16/2022] Open
Abstract
Background A number of screening techniques have been developed to reduce the incidence of cervical cancer, most common of which is conventional Pap smear (CPS) being overtaken by liquid-based cytology (LBC) in most of the developed countries. There are a number of studies with conflicting results, and no method has been shown superior in terms of all parameters. LBC was introduced in our hospital in 2014, and we planned to do a study and compare results of the two techniques. This study aims to compare the two methods in terms of sensitivity, specificity, positive predictive value and negative predictive value, turnover time, cost-effectiveness, sample adequacy. This study has been done in 100 women with unhealthy cervix to increase the output. Method This was a prospective observational study. A total of 100 women fulfilling the inclusion criteria were subjected to screening test. In first 50 cases, first conventional Pap smear was taken and then LBC, and in remaining 50 cases, first LBC and then conventional Pap smear were taken; this was done to remove bias. Results The number of unsatisfactory slides was reduced with LBC, and turnover time was less for LBC. The detection of ASCUS was increased with LBC, but the detection of higher-grade lesions (HSIL and SCC) was equal with both tests. Conclusion The superiority of LBC with respect to reduction in the number of unsatisfactory slides and less turnover time is being offset with increased detection of low-grade lesions subjecting women to further testing increasing the cost of programme and anxiety among women. It is difficult to say that it can completely replace conventional Pap smear in low-resource settings.
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Affiliation(s)
- Vasundhara Kamineni
- Department of Obstetrics and Gynaecology, KAMSRC, LB Nagar, Hyderabad, India
| | - Priti Nair
- Department of Obstetrics and Gynaecology, KAMSRC, LB Nagar, Hyderabad, India
| | - Ashok Deshpande
- Department of Pathology, KAMSRCl, LB Nagar, Hyderabad, India
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7
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Fischer G, Cormier K. Glandular Cell Abnormalities on SurePath Preparations: A Retrospective Review with Cytology-Histology Correlations. Acta Cytol 2018; 62:423-429. [PMID: 30244241 DOI: 10.1159/000493000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 08/20/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Detecting glandular lesions is challenging by all Pap test methodologies. As the availability of data on identifying glandular abnormalities by SurePath is scarce, we investigated the detection rates and the correlation with histology follow-up. STUDY DESIGN A total of 105,927 cases (SurePath and conventional) were searched for the diagnosis of atypical glandular cells or higher glandular abnormalities (AGC+) with the corresponding histologic diagnosis. The associations between the Pap test methods and diagnostic categories were assessed by χ2 test. RESULTS Overall, 0.32% of SurePath (159/49,375) and 0.29% of conventional (164/56,552) cases showed AGC+ (p = 0.38). Histology confirmed significant abnormalities in 42 versus 53.5% of the cases, respectively (p = 0.064); 72.7% (SurePath) versus 65.2% (conventional) of these were glandular in nature (p = 0.37). The diagnosis of neoplasia (favored or definitive) showed malignancy on follow-up in 100% of SurePath cases (12/12). In contrast, 82.1% of these conventional cases disclosed premalignant or malignant lesions by histology (p = 0.12). CONCLUSIONS AGC+ cases showed higher prevalence on SurePath preparations. Conventional cases had more abnormalities on follow-up, while glandular lesions represented a higher proportion of abnormal histologies following SurePath AGC+s. The positive predictive value of favored or definite neoplasia was higher in SurePath cases. Overall, these differences were not statistically significant.
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8
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Kim MK, Lee YK, Hong SR, Lim KT. Clinicopathological significance of atypical glandular cells on cervicovaginal Pap smears. Diagn Cytopathol 2017; 45:867-872. [DOI: 10.1002/dc.23777] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/25/2017] [Accepted: 06/15/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Mi-Kyung Kim
- Department of Obstetrics and Gynecology; Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine; Seoul Republic of Korea
| | - Yoo Kyung Lee
- Department of Obstetrics and Gynecology; Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine; Seoul Republic of Korea
| | - Sung Ran Hong
- Department of Pathology; Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine; Seoul Republic of Korea
| | - Kyung Taek Lim
- Department of Obstetrics and Gynecology; Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine; Seoul Republic of Korea
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9
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Haghighi F, Ghanbarzadeh N, Ataee M, Sharifzadeh G, Mojarrad JS, Najafi-Semnani F. A comparison of liquid-based cytology with conventional Papanicolaou smears in cervical dysplasia diagnosis. Adv Biomed Res 2016; 5:162. [PMID: 27995101 PMCID: PMC5137229 DOI: 10.4103/2277-9175.192735] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 01/30/2016] [Indexed: 11/18/2022] Open
Abstract
Background: Due to the high number of women affected by cervical cancer and the importance of an early diagnosis, combined with the frequent incidence of false-negative Papanicolaou (Pap) smear screening results for this disease, several studies have been conducted in recent years in order to find better tests. Liquid-based cytology (LBC) tests, including the liquid-based thin layer method, have demonstrated the highest potential for reducing false-negative cases and improved sample quality. This study aimed to compare the strength of the Pap smear test with fluid cytology and conventional tests in detecting cervical dysplasia. Materials and Methods: This descriptive-analytic study was conducted on 366 women who attended private laboratories for a Pap smear. The Pap smear sampling was conducted simultaneously using two methods: conventional Pap (CP) smear and LBC), from the cervix. Results: The mean age of the participants was 32 ± 8.8 years. Diagnostic results of endocervical cells, epithelial cells, vaginitis cells, and metaplastia were consistent with both conventional and liquid cytology smears, and the kappa coefficient was determined to be significant (P < 0.001). In total, 40.5% of diagnostic cases indicated bacterial inflammation 80.3% of the diagnoses in both methods were P1 and 3.9% of cases diagnosed were P2, the overall diagnostic consistency was 83.9% between the two sampling methods. The inflammation diagnosis was 40.5% and this was consistent in both methods of LBC and CP. There was one case of a false-negative diagnosis in the LBC method and 14 cases in the CP method. Conclusion: Results showed that the LBC may improve the sample's quality and reduce the number of unsatisfactory cases more than with the CP method.
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Affiliation(s)
- Fatemeh Haghighi
- Department of Pathology, Birjand University of Medical Sciences, Birjand, Iran
| | - Nahid Ghanbarzadeh
- Department of Gynecology and Obstetrics, Birjand University of Medical Sciences, Birjand, Iran
| | - Marziee Ataee
- Department of Gynecology and Obstetrics, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Javid Shahbazi Mojarrad
- Department of Medicinal Chemistry, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Najafi-Semnani
- Faculty of Medicine, Member of Student Research Committee, Tehran University of Medical Science, Tehran, Iran
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10
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Fujii T, Asano A, Shimada K, Tatsumi Y, Obayashi C, Konishi N. Evaluation of RNA and DNA extraction from liquid-based cytology specimens. Diagn Cytopathol 2016; 44:833-40. [PMID: 27357064 DOI: 10.1002/dc.23524] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/06/2016] [Accepted: 06/14/2016] [Indexed: 12/11/2022]
Abstract
Molecular diagnosis using DNA and RNA derived from malignant tumors and molecular biological tools such as the quantitative polymerase-chain-reaction (qPCR) is a commonly used technique in clinical pathology. In this report, we compared the qualitative extraction of RNA and DNA from cancer cells fixed using several liquid-based cytology (LBC) kits. Ten to 1,000 cells from the T24 urinary bladder cancer cell line and SKG-II cervical cancer cell line were fixed with 55% methanol and three different methanol-based LBC solutions. The mRNA levels of CD44 in T24 cells and E7 in SKG-II cells and DNA levels of p53 in T24 cells and E7 in SKG-II cells were analyzed by qPCR. mRNA and DNA extracted from T24 and/or SKG-II cells fixed with methanol-based LBC solutions were efficiently detected, but to differing degrees, by qPCR. mRNA, and DNA from cells fixed with a formaldehyde-containing fixative liquid were detected at significantly low copy numbers by qPCR. Our results demonstrate that LBC systems are powerful tools for cytopathology and immunocytochemistry applications. However, the appropriate fixative must be selected for cell preservation when a small number of LBC samples is used for molecular testing, particularly in RNA-based molecular analyses. Diagn. Cytopathol. 2016;44:833-840. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Tomomi Fujii
- Department of Pathology, Nara Medical University School of Medicine, Nara, Japan.
| | - Aya Asano
- Department of Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Keiji Shimada
- Department of Pathology, Nara Medical University School of Medicine, Nara, Japan.,Department of Diagnostic Pathology, Nara City Hospital, Nara, Japan
| | - Yoshihiro Tatsumi
- Department of Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Chiho Obayashi
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Noboru Konishi
- Department of Pathology, Nara Medical University School of Medicine, Nara, Japan
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11
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Gupta N, Crossley J, Dudding N, Smith JHF. Endometrial Adenocarcinoma in SurePath™ Cervical Samples: Cytological Features Revisited. Acta Cytol 2016; 60:46-52. [PMID: 26934466 DOI: 10.1159/000444043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 01/04/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The cytomorphological criteria of malignant endometrial lesions in cervical samples are less well described than those of cervical lesions. We wished to investigate if there were features in SurePath™ liquid-based cytology samples that would facilitate more accurate differentiation between benign and malignant endometrial cells. STUDY DESIGN This was a two-phase study, with a review of all SurePath™ samples reported as endometrial adenocarcinoma (n = 42) evaluating 12 cytological features in the first phase. In phase 2 (test set), all initial cases plus an additional 83 cases were reviewed using these 12 cytological features to predict the outcome. RESULTS Out of 12 cytological features evaluated in phase 1 (training set), nuclear chromatin pattern, apoptotic bodies and tingible body macrophages were found to be the most significant features determining malignant histological outcome. These 12 cytological features were re-evaluated in phase 2 (n = 125). Of 125 cases, 54 had a benign and 71 had a malignant or premalignant histological outcome, with a positive predictive value of 56.8%. CONCLUSION Granular nuclear chromatin, tingible body macrophages and apoptosis in the background are the most significant factors in determining whether endometrial cells present in cervical samples represent malignancy or are benign. Using these features, relatively accurate predictions of endometrial pathology can be made.
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Affiliation(s)
- Nalini Gupta
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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12
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Serdy K, Yildiz-Aktas I, Li Z, Zhao C. The Value of Papanicolaou Tests in the Diagnosis of Endometrial Carcinoma: A Large Study Cohort From an Academic Medical Center. Am J Clin Pathol 2016; 145:350-4. [PMID: 27124917 DOI: 10.1093/ajcp/aqv085] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To determine on a large scale whether routine cervical Papanicolaou (Pap) tests play a role in endometrial carcinoma diagnosis. METHODS A retrospective search of an academic women's hospital pathology archive for cases of surgically resected endometrial carcinoma with Pap smears within 36 months before the histologic diagnosis was performed. Demographic features, Pap test results, and tumor features were recorded. RESULTS We identified 554 (30.5%) of 1,817 cases of endometrial carcinoma with documented Pap test results within 36 months before histologic diagnosis. Among these 554 patients, 405 (73.0%) had Pap test results within 5 months before histologic diagnosis. In total, 154 (38%) cases demonstrated abnormal glandular cells, and 25 (6.2%) had only benign endometrial cells in women 40 years or older. The presence of glandular abnormality on the Pap test is significantly correlated with tumor size, tumor type, depth of invasion, presence of cervical involvement, and presence of lymphovascular invasion (P < .05). The rate of detecting abnormal glandular cells was higher in cases with a high International Federation of Gynecology and Obstetrics (FIGO) stage than in cases with a low FIGO stage (47.5% vs 35.5%; P < .05). CONCLUSIONS The Pap test may play a role in the detection of endometrial carcinoma, especially for those with cervical involvement, lymphovascular invasion, and/or advanced stage.
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Affiliation(s)
- Kate Serdy
- From the Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Isil Yildiz-Aktas
- From the Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Zaibo Li
- Department of Pathology, Ohio State University Medical Center, Columbus
| | - Chengquan Zhao
- From the Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA;
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13
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Bansal B, Gupta P, Gupta N, Rajwanshi A, Suri V. Detecting uterine glandular lesions: Role of cervical cytology. Cytojournal 2016; 13:3. [PMID: 27014363 PMCID: PMC4785776 DOI: 10.4103/1742-6413.177156] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/23/2015] [Indexed: 11/21/2022] Open
Abstract
Background: The sensitivity of cervical cytology for detection of glandular lesions is reported to be low. We conducted this study to assess the diagnostic accuracy of cervical Papanicolaou (Pap) smears for uterine glandular lesions and to compare the diagnostic utility of conventional and liquid-based cytology (LBC) smears for glandular lesions. Materials and Methods: Archived histopathology records of all cases reported as endocervical and endometrial adenocarcinoma in the study period were identified and the available corresponding Pap smears (in preceding 1 year) were retrieved. In addition, the Pap smears reported as glandular cell abnormalities (GCA) during the same study period were retrieved. The overall prevalence of GCA, sensitivity, and specificity of Pap smears for the detection of GCA was calculated. The diagnostic accuracy of conventional and LBC smears for the diagnosis of GCA was also compared. Results: The prevalence of GCA in our study was 0.32%. The overall specificity of Pap smears for the diagnosis of GCA was 60.8%, this was not significantly different between conventional and LBC smears (P = 0.4). The overall sensitivity of Pap smears for the detection of GCA was 41.8%; LBC smears had significantly better sensitivity as compared to conventional smears for the detection of endometrial as compared to endocervical adenocarcinoma (P < 0.05). Conclusions: The prevalence of GCA in Pap smears is low. The specificity of Pap smears, for diagnosis of GCA, was found to be moderate. However, the overall sensitivity of Pap smears for the detection of GCA was low, though better for LBC as compared to conventional smears.
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Affiliation(s)
- Baneet Bansal
- Address: Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parikshaa Gupta
- Address: Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Address: Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Address: Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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14
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Hanley KZ, Oprea-Ilies G, Ormenisan C, Seydafkan S, Mosunjac MB. Atypical Findings on Cervicovaginal Smears Correlate with Cervical Involvement by Malignant Mixed Müllerian Tumors of the Uterus. Acta Cytol 2015; 59:319-24. [PMID: 26315658 DOI: 10.1159/000439159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/03/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE A malignant mixed müllerian tumor (MMMT) is a high-grade neoplasm commonly arising from the uterus. Patients present with bleeding and a mass protruding from the cervix. This study was designed to correlate Papanicolaou (Pap) smear findings with histological findings in women diagnosed with MMMT. STUDY DESIGN Women diagnosed with MMMT were identified. Preoperative Pap tests were correlated with histological findings. Statistical analysis was performed to assess associations between abnormal Pap tests and histological findings. RESULTS Forty patients with MMMT were included in the study. Age ranged from 37-85 years and tumor size ranged from 1.2 to 21 cm. In presurgical Pap tests (4 conventional and 36 liquid based), 11 smears (27.5%) were diagnosed as negative, 5 (12.5%) as atypical squamous cells of undetermined significance, 6 (15%) as atypical glandular cells, 16 (40%) as malignant and 2 (5%) as high-grade squamous intraepithelial lesion. Malignant cells detected on Pap smears showed a strong correlation with endocervical involvement by MMMT (p = 0.002). Larger tumors were more likely to involve the cervix (p = 0.0115). CONCLUSIONS The Pap test can predict cervical involvement by MMMT. On Pap smears, MMMT cells showed no correlation with other adverse histological features (lymphovascular invasion, myoinvasion or adnexal involvement).
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Affiliation(s)
- Krisztina Z Hanley
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Ga., USA
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Kosmas K, Stamoulas M, Marouga A, Kavantzas N, Patsouris E, Athanassiadou P. Expression of p53 in imprint smears of endometrial carcinoma. Diagn Cytopathol 2013; 42:416-22. [PMID: 24167025 DOI: 10.1002/dc.23056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 06/19/2013] [Accepted: 08/30/2013] [Indexed: 11/11/2022]
Abstract
The aims of this study were to determine the expression of p53 protein in endometrial adenocarcinomas (as a potential prognostic indicator before treatment) as well as normal endometrium in imprint smears and to correlate the results with clinicopathologic parameters of primary untreated endometrial cancer patients. Two hundred fifty five patients were evaluated with endometrial imprint cytology during a 29-month period. Endometrial samples freshly resected from women who underwent total abdominal hysterectomy were studied. One hundred twenty six patients had endometrial carcinoma and 129 cases were diagnosed as normal endometrium. The expression of p53 was assessed by immunocytochemistry. Positive staining was correlated with increased surgical-pathological stage, histological grade and lymph node metastases. High expression of p53 staining was significantly more frequent in histological type II than type I endometrial adenocarcinoma. High-grade endometrial carcinoma had higher proportions and stronger intensity compared with low-grade carcinoma. Negative immunostain for p53 protein was found in proliferative, secretory, and atrophic endometrium. Immunocytochemical findings from p53 stain, in addition to cytomorphologic features, appeared to be useful in the diagnosis and in the postoperative prognosis of endometrial carcinoma in endometrial cytology, especially if combined with other markers. High p53 expression correlates with morphologic features of aggressiveness and the expression pattern of p53 correspond to the expected cyclic/atrophic pattern in normal endometrium.
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Affiliation(s)
- Konstantinos Kosmas
- Department of Cytopathology, Anti-cancer Oncological Hospital St. Savvas, Athens, Greece
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Sams SB, Currens HS, Raab SS. Liquid-based Papanicolaou tests in endometrial carcinoma diagnosis. Performance, error root cause analysis, and quality improvement. Am J Clin Pathol 2012; 137:248-54. [PMID: 22261450 DOI: 10.1309/ajcplfbk1a2xjdqi] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Recent reports show that the sensitivity of endometrial carcinoma detection on liquid-based Papanicolaou (Pap) tests (88%) is considerably higher than that reported on conventional Pap smears (20%-30%), although few laboratories have corroborated these results. We performed a 5-year retrospective review of all liquid-based Pap tests (n = 69) in women who later were given a diagnosis of endometrial carcinoma, performed error root cause analysis, and developed quality improvement initiatives as a means of error reduction. The original and rescreened Pap test sensitivity rates for endometrial carcinoma were 31.9% and 59.3%, respectively. Root cause analysis showed that poor specimen quality and cognitive failures contributed to a false-negative error in 67% (18/27) and 59% (16/27), respectively, of all cases. System analysis showed that latent factors contributing to error included lack of redundant and educational systems. We conclude that system redesign of liquid-based Pap test screening processes has the potential to improve sensitivity in endometrial carcinoma diagnosis.
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Bowditch RC, Clarke JM, Baird PJ, Greenberg ML. Results of an Australian trial using SurePath liquid-based cervical cytology with Focalpoint computer-assisted screening technology. Diagn Cytopathol 2011; 40:1093-9. [DOI: 10.1002/dc.21848] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 08/26/2011] [Indexed: 12/22/2022]
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Talaat A, Brinkmann D, Dhundee J, Hana Y, Bevan J, Irvine R, Bailey S, Woolas R. Risk of significant gynaecological pathology in women with ?glandular neoplasia on cervical cytology. Cytopathology 2011; 23:371-7. [DOI: 10.1111/j.1365-2303.2011.00891.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yarandi F, Izadi-Mood N, Eftekhar Z, Shojaei H, Sarmadi S. Diagnostic accuracy of dilatation and curettage for abnormal uterine bleeding. J Obstet Gynaecol Res 2011; 36:1049-52. [PMID: 21058439 DOI: 10.1111/j.1447-0756.2010.01288.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The objective of this study was to compare the histological findings of dilatation and curettage (D&C) with those on subsequent hysterectomy in patients with abnormal uterine bleeding. METHODS Between October 1998 and September 2003 a retrospective clinical study of 311 patients was conducted, including all patients who underwent D&C and within 2 months, hysterectomy because of histological findings on D&C or persistence of symptoms. The sensitivity, specificity, positive and negative predictive value and accuracy of D&C were studied. RESULTS The mean age of our patients was 46.6 years. In 164 of 311 patients (52.7%), D&C failed to detect intrauterine disorders subsequently found at hysterectomy. The sensitivity was 30.2%, the specificity was 72.3%, the positive predictive value was 77.1%, and the negative predictive value was 25.1%. The accuracy was 40.5% overall. CONCLUSION D&C is an inadequate diagnostic tool for uterine focal lesions, but the accuracy of D&C in the detection of endometrial hyperplasia and carcinoma is relatively high (92.1%).
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Affiliation(s)
- Fariba Yarandi
- Department of Gynecological Oncology, Mirza Koochak Khan Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Negri G. Atypical glandular cells in cervical cytology: what are we talking about? Terminology and the impact of molecular techniques. Cytopathology 2009; 20:347-50. [PMID: 19929982 DOI: 10.1111/j.1365-2303.2009.00718.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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