Cytological Diagnoses of Adenocarcinoma in situ of the Cervix: Common Misdiagnoses

Objective: In routine screening, glandular lesions have high false-negative and false-positive rates. Our study sought to improve the cytological diagnoses and differentiation of glandular lesions. Study Design: A total of 24 cytology slides were retrospectively reviewed. Among these slides, 15 were confirmed via histology to have varying amounts of adenocarcinoma in situ (AIS) components. The other 9 cytology slides exhibited AIS mimics that had been originally considered to be AIS or atypical glandular cells (AGCs) and were selected for differentiation from AIS. Results: Overall, 12 of the 15 cytological slides exhibited significant atypical glandular features that met the criteria for AIS. However, the original cytological diagnoses included 2 cases of AIS, 3 AGCs-favor neoplasia (AGC-FN), 2 AGCs, 1 case that was not otherwise specified (AGC-NOS), 1 NILM (negative for intraepithelial lesion and malignancy), 3 HSILs (high-grade squamous intraepithelial lesions), and 2 ASC-Hs (atypical squamous cells, cannot exclude HSIL). The latter 9 cytological slides were subsequently histologically confirmed to be 2 metaplasias, 2 reactive lesions, 1 decidual change, 3 serous adenocarcinomas, and 1 SCNEC (small-cell neuroendocrine carcinoma). Conclusion: Cytological screening will be valuable for identifying glandular lesions as effectively as squamous lesions if the doubly high false rates can be decreased.

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Significance of High-Risk Human Papillomavirus Testing for Atypical Glandular Cells on Cervical Cytology

Acta Cytologica ◽

10.1159/000490230 ◽

2018 ◽

Vol 62 (5-6) ◽

pp. 405-410 ◽

Cited By ~ 2

Author(s):

Hiroaki Komatsu ◽

Tetsuro Oishi ◽

Daiken Osaku ◽

Mayumi Sawada ◽

Akiko Kudoh ◽

...

Keyword(s):

Human Papillomavirus ◽

High Risk ◽

Intraepithelial Neoplasia ◽

Adenocarcinoma In Situ ◽

Diagnostic Significance ◽

Predictive Values ◽

Squamous Cells ◽

Glandular Cells ◽

Atypical Glandular Cells

Objectives: The aim of this study was to evaluate the diagnostic significance of high-risk human papillomavirus (hrHPV) testing for managing women with atypical glandular cells (AGC) and to explore the distribution of hrHPV genotypes. Methods: We analyzed cytologic and histopathologic diagnoses in patients referred to our institution due to AGC or atypical squamous cells of undetermined significance (ASC-US). All patients underwent hrHPV testing and genotyping, and positive (PPV) and negative predictive values (NPV) for cervical intraepithelial neoplasia (CIN) 2 or worse [CIN2+/adenocarcinoma in situ (AIS)+] were calculated. Results: Among 41 cases previously diagnosed with AGC, 22 (53%) were classified as CIN2+ (2 squamous cell carcinomas), whereas only 2 were AIS or adenocarcinoma. Twenty-seven (65.8%) cases in the AGC group were hrHPV positive. The most frequent genotypes in both the ASC-US and AGC groups were HPV16 and HPV52. The PPV of hrHPV testing for CIN2+/AIS+ was significantly higher in the AGC than in the ASC-US group (74.1 vs. 35.0%; p = 0.0005). The NPV for CIN2+/AIS+ was significantly lower in the AGC than in the ASC-US group (74.4 vs. 100%; p = 0.0441). Conclusion: In patients with AGC, both glandular and squamous lesions must be monitored. hrHPV testing is useful for detecting CIN2+/AIS+ in AGC.

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Abstract 3680: Comparison of risk of advanced cervical lesions among women with first detection of atypical squamous cells, atypical glandular cells, and low-grade squamous intraepithelial lesions by Pap smear

10.1158/1538-7445.am2011-3680 ◽

2011 ◽

Author(s):

Yun-Yuan Chen ◽

San-Lin You ◽

Shin-Lan Koong ◽

Chi-An Chen ◽

Chien-Jen Chen ◽

...

Keyword(s):

Pap Smear ◽

Low Grade ◽

Squamous Intraepithelial Lesions ◽

Cervical Lesions ◽

Squamous Cells ◽

Glandular Cells ◽

Atypical Glandular Cells ◽

Intraepithelial Lesions

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Human papillomavirus DNA detection and histological findings in women referred for atypical glandular cells or adenocarcinoma in situ in their Pap smears

Gynecologic Oncology ◽

10.1016/j.ygyno.2004.08.033 ◽

2004 ◽

Vol 95 (3) ◽

pp. 618-623 ◽

Cited By ~ 42

Author(s):

Sophie Françoise Mauricette Derchain ◽

Silvia Helena Rabelo-Santos ◽

Luis Otávio Sarian ◽

Luiz Carlos Zeferino ◽

Eliane Regina de Oliveira Zambeli ◽

...

Keyword(s):

Human Papillomavirus ◽

Dna Detection ◽

Pap Smears ◽

Adenocarcinoma In Situ ◽

Histological Findings ◽

Glandular Cells ◽

Atypical Glandular Cells ◽

Papillomavirus Dna

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Detection of Adenocarcinoma In Situ of the Cervix in Papanicolaou Tests: Comparison of Diagnostic Accuracy With Other High-Grade Lesions

Archives of Pathology & Laboratory Medicine ◽

10.5858/2004-128-153-doaiso ◽

2004 ◽

Vol 128 (2) ◽

pp. 153-157 ◽

Cited By ~ 5

Author(s):

Andrew A. Renshaw ◽

Dina R. Mody ◽

Richard L. Lozano ◽

Emily E. Volk ◽

Molly K. Walsh ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Interlaboratory Comparison ◽

False Negative ◽

Adenocarcinoma In Situ ◽

High Grade ◽

Squamous Intraepithelial Lesion ◽

Intraepithelial Lesion

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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Atypical glandular cells and adenocarcinoma in situ according to the Bethesda 2001 classification: Cytohistological correlation and clinical implications

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2007.08.017 ◽

2008 ◽

Vol 139 (1) ◽

pp. 79-85 ◽

Cited By ~ 21

Author(s):

Maria C. Westin ◽

Sophie F. Derchain ◽

Silvia H. Rabelo-Santos ◽

Liliana A. Angelo-Andrade ◽

Luis O. Sarian ◽

...

Keyword(s):

Clinical Implications ◽

Adenocarcinoma In Situ ◽

Glandular Cells ◽

Atypical Glandular Cells

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Management of Atypical Glandular Cells and Adenocarcinoma in Situ

Obstetrics and Gynecology Clinics of North America ◽

10.1016/j.ogc.2008.09.002 ◽

2008 ◽

Vol 35 (4) ◽

pp. 623-632 ◽

Cited By ~ 8

Author(s):

Charles J. Dunton

Keyword(s):

Adenocarcinoma In Situ ◽

Glandular Cells ◽

Atypical Glandular Cells

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Can an inadequate cervical cytology sample in ThinPrep be converted to a satisfactory sample by processing it with a SurePath preparation?

CytoJournal ◽

10.4103/cytojournal.cytojournal_34_16 ◽

2017 ◽

Vol 14 ◽

pp. 20 ◽

Cited By ~ 1

Author(s):

Sveinung Wergeland Sørbye ◽

Mette Kristin Pedersen ◽

Bente Ekeberg ◽

Merete E. Johansen Williams ◽

Torill Sauer ◽

...

Keyword(s):

Screening Program ◽

Clinical Pathology ◽

Intraepithelial Neoplasia ◽

University Hospital ◽

Low Grade ◽

Squamous Intraepithelial Lesion ◽

Squamous Cells ◽

Glandular Cells ◽

Atypical Glandular Cells ◽

Intraepithelial Lesion

Background: The Norwegian Cervical Cancer Screening Program recommends screening every 3 years for women between 25 and 69 years of age. There is a large difference in the percentage of unsatisfactory samples between laboratories that use different brands of liquid-based cytology. We wished to examine if inadequate ThinPrep samples could be satisfactory by processing them with the SurePath protocol. Materials and Methods: A total of 187 inadequate ThinPrep specimens from the Department of Clinical Pathology at University Hospital of North Norway were sent to Akershus University Hospital for conversion to SurePath medium. Ninety-one (48.7%) were processed through the automated “gynecologic” application for cervix cytology samples, and 96 (51.3%) were processed with the “nongynecological” automatic program. Results: Out of 187 samples that had been unsatisfactory by ThinPrep, 93 (49.7%) were satisfactory after being converted to SurePath. The rate of satisfactory cytology was 36.6% and 62.5% for samples run through the “gynecology” program and “nongynecology” program, respectively. Of the 93 samples that became satisfactory after conversion from ThinPrep to SurePath, 80 (86.0%) were screened as normal while 13 samples (14.0%) were given an abnormal diagnosis, which included 5 atypical squamous cells of undetermined significance, 5 low-grade squamous intraepithelial lesion, 2 atypical glandular cells not otherwise specified, and 1 atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion. A total of 2.1% (4/187) of the women got a diagnosis of cervical intraepithelial neoplasia 2 or higher at a later follow-up. Conclusions: Converting cytology samples from ThinPrep to SurePath processing can reduce the number of unsatisfactory samples. The samples should be run through the “nongynecology” program to ensure an adequate number of cells.

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The Effect of Continuous Monitoring of Cytologic-Histologic Correlation Data on Cervical Cancer Screening Performance

Archives of Pathology & Laboratory Medicine ◽

10.5858/2008-132-16-teocmo ◽

2008 ◽

Vol 132 (1) ◽

pp. 16-22 ◽

Cited By ~ 2

Author(s):

Stephen S. Raab ◽

Bruce A. Jones ◽

Rhona Souers ◽

Joseph A. Tworek

Keyword(s):

Predictive Value ◽

Continuous Monitoring ◽

False Negative ◽

Pap Test ◽

Mixed Linear Model ◽

Squamous Cells ◽

Test Sensitivity ◽

Correlation Data ◽

Glandular Cells ◽

Atypical Glandular Cells

Abstract Context.—The use of Papanicolaou (Pap) test cytologic-histologic correlation in quality improvement activities is not well studied. Objective.—To determine if continuous monitoring of correlation data improves performance. Design.—Participants in the College of American Pathologists Q-Tracks program (213 laboratories) self-reported the number of Pap test–histologic biopsy correlation discrepancies every quarter for up to 8 years. A mixed linear model determined if the length of participation in the Q-Tracks program was associated with improved performance. Main outcome measures were predictive value of a positive Pap test, Pap test sensitivity, sampling sensitivity, and proportion of positive histologic diagnoses following a Pap test diagnosis of atypical squamous cells or atypical glandular cells. Results.—Institutions evaluated 287 570 paired Pap test– histologic correlation specimens and found 98 424 (34.2%) true-positive Pap test correlations, 19 006 (6.6%) false-positive Pap test correlations, and 6575 (2.3%) false-negative Pap test correlations. The mean predictive value of a positive Pap test, sensitivity, screening and interpretive sensitivity, sampling sensitivity, and proportion of positive histologic diagnoses following a Pap test diagnosis of atypical squamous or glandular cells were 83.6%, 93.7%, 99.2%, 94.2%, 60.3%, and 38.8%, respectively. Longer participation was significantly associated with a higher predictive value of a positive Pap test (P = .01), higher Pap test sensitivity (P = .002), higher Pap test sampling sensitivity (P = .03), and higher proportion of positive histologic diagnoses for a Pap test diagnosis of atypical squamous cells (P < .001). Conclusions.—Long-term monitoring of cytologic-histologic correlation is associated with improvement in cytologic-histologic correlation performance.

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