Adenocarcinoma of the cervix

Abstract

BACKGROUND.The current study examines 1) the sensitivity of detection of invasive adenocarcinoma of the cervix in a routine cervical screening service, and 2) the frequency in smears of cytologic criteria previously found to be useful in diagnosis. METHODS. RESULTS.Thirty-six smears from 24 women were reviewed. Of those, 58.3% had been reported as a possible or definite high grade epithelial abnormality (HGEA). On review it was thought that this could be improved to 77.8%. The screening or diagnostic error was thus 19.4% and the sampling error 22.2%. The likelihood of an individual woman receiving a report of a possible or definite HGEA in the three years before biopsy was 83.3%. In retrospect this could have been improved to 91.7%. Heavy bloodstaining with abundant abnormal glandular epithelium (14 smears) and small three-dimensional or papillary clusters (16 smears) were the most frequent clues to invasion.Tumor necrosis/diathesis was present in eight smears, but easily seen in only four, while marked nuclear pleomorphism and macronucleoli were seen in three and one smears respectively. In cases with a discrepancy between the initial and the review findings, very small amounts of abnormal material (three smears), a resemblance to endometrial cells (one smear), and an unusual appearance of folded monolayered sheets (three smears) contributed to the difficulty of diagnosis.CONCLUSIONS. There were significant sampling and screening/diagnostic errors (22.2% and 19.4%, respectively). Screening and diagnostic errors could perhaps be reduced by a greater awareness of the range of cytologic changes, but these may be subtle. Heavy bloodstaining with abundant abnormal glandular material may be a useful clue to invasive, rather than in situ, adenocarcinoma, even in the absence of tumor diathesis or fully malignant nuclear criteria. Cancer (Cancer Cytopathol) 2002;96:5-13.

Adenocarcinoma in situ of the uterine cervix

“…A limited number of smears did contain focal background debris, but none exhibited widespread diathesis. In contrast to previously examined invasive carcinomas, 37 only one case exhibited marked blood staining, reinforcing the value of this criterion in suggesting invasion. However, other features that are characteristic of invasive tumors, such as small papillary or three-dimensional groups, were seen in some cases and were prominent in a small number of smears.…”

“…This change in policy would have led to the sending of only one additional case out of the eight in question for gynecologic review. The main objective of our studies of glandular lesions of the endocervix 6,37 has been to increase diagnostic skills within the laboratory, and there were some signs of an improvement in approach over the course of the study. Only 2 of the 8 errors described above occurred in the last 3 years of the study period.…”

Morphoquantitative Analysis of the Intraepithelial Neoplasic Uterine Cells by Computer Image System

“…Meanwhile, a good technique usage in DNA proof needs knowledge, standardization from the beginning of the material acquisition and its fixation, to the histochemic marker and reading from computerized equipments, to get precise diagnostics (Zuna et al, 2002). When we compared our findings with Arcuri et al (2002) and Schoolland et al (2002), we found a huge percentage of unused material, for failure to reach a proof of basic conditions, or simply having mistaken diagnostics. We know, public hospitals have different financing cycles in a year, thus, usually allowing a usage of different fixing agents, difficulties in storage and handling so, standardizing the beginning of the process is essential independently from a technique to be used.…”

Decreasing incidence of cervical adenocarcinoma in Ontario: Is this related to improved endocervical Pap test sampling?

“…It has been hypothesized that improved sampling, recognition and awareness of glandular lesions in cytology screening resulted in higher AIS rates, and that the delayed impact of screening would eventually translate into decreased AC rates. 8 An Australian study by Schoolland et al 40 examined the effect of endocervical brushes on collection of cells from the transformation zone. Schoolland referenced unpublished data indicating that the percentage of Pap tests with endocervical cells had increased to 85-90% from an estimated 50-60% prior to introduction of new collection devices.…”

“…Seven studies suggested the potential benefits of improved sampling due to use of endocervical brush and better identification of precursor lesions, thereby reducing progression to adenocarcinoma. 8,13,21,[40][41][42][43] In Ontario, the endobrush was first recommended in 1989 through the publication of ''The Adequate Pap Smear,'' which detailed proper collection techniques. 44 Many clinicians had already adopted this format several years prior to the recommendations.…”