Clinical Significance of a Cytologic Diagnosis of Atypical Glandular Cells, Favor Endometrial Origin, in Pap Smears

Takei, Hidehero; Liu, Yulin L.; Silverman, Jan F.; Lipscomb, Jane T.; Ruiz, Bernardo

doi:10.1159/000325894

Cited by 15 publications

(9 citation statements)

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“…13,14 The category of "AGC of endometrial origin" in our study had a higher predictive value of abnormal histology (14 of 26 [54%] vs. 24 of 65 [37%]), but the difference was not statistically significant (p = 0.139) ( Table III). The study of Saad et al 15 revealed similar data. The "AGC of endometrial origin, favor neoplastic" category in our study had a predictive rate for abnormal histology of 100%.…”

Section: Cytologic Findingsmentioning

confidence: 58%

Clinical Significance of Atypical Glandular Cells by the 2001 Bethesda System in Cytohistologic Correlation

et al. 2008

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Section: Cytologic Findingsmentioning

confidence: 58%

Clinical Significance of Atypical Glandular Cells by the 2001 Bethesda System in Cytohistologic Correlation

et al. 2008

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“…Mitotic figures are not typically seen in exfoliated cells but may be seen in directly sampled cells [3]. Benign endometrial cell HCG spontaneously shed in menstrual smears may especially show concerning degenerative chromatin changes, but the cell groups typically lack features commonly described in neoplasia [20], especially the more pronounced nuclear atypia seen at least in higher grade endometrial cancers [21]. Tubal metaplasia of the endometrium and other forms of endometrial metaplasia, also termed epithelial cytoplasmic change [22], have been much more frequently recognized in endometrial surgical pathology specimens than in cytology specimens.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Chivukula¹,

Austin²,

Shidham³

2007

Cytojournal

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ObjectiveHyperchromatic crowded groups (HCG), a term first introduced into the cytology literature by DeMay in 1995, are commonly observed in Pap tests and may rarely be associated with serious but difficult to interpret lesions. In this study, we specifically defined HCG as dark crowded cell groups with more than 15 cells which can be identified at 10× screening magnification.MethodsWe evaluated consecutive liquid-based (Surepath) Pap tests from 601 women (age 17–74 years, mean age 29.4 yrs) and observed HCG in 477 cases. In all 477 HCG cases, Pap tests were found to be satisfactory and to contain an endocervical sample. HCG were easily detectible at 10× screening magnification (size up to 400 um, mean 239.5 um) and ranged from 1 to 50 (mean 19.5) per Pap slide.ResultsHCG predominantly represented 3-Dimensional groups of endocervical cells with some nuclear overlap (379/477 – 79%), reactive endocervical cells with relatively prominent nucleoli and some nuclear crowding (29/477 – 6%), clusters of inflammatory cells (25/477 – 5.2%), parabasal cells (22/477 – 4.6%), endometrial cells (1/477 – 0.2%). Epithelial cell abnormalities (ECA) were present in only 21 of 477 cases (4.6%). 18 of 21 women with HCG-associated ECA were less than 40 years old; only 3 were =/> 40 years. HCG-associated final abnormal Pap test interpretations were as follows: ASCUS (6/21 – 28%), LSIL (12/21 – 57%), ASC-H (2/21 – 9.5%), and HSIL/CIN2-3 (3/21 – 14%). The association of HCG with ECA was statistically significant (p = 0.0174. chi-square test). In patients with ECA, biopsy results were available in 10 cases, and 4 cases of biopsy-proven CIN2/3 were detected. Among these four cases, HCG in the Pap tests, in retrospect represented the lesional high grade cells in three cases (one HSIL case and two ASC-H cases). Interestingly, none of the 124 cases without HCG were found to have an epithelial cell abnormality.ConclusionWe conclude: a. HCG are observed in a high proportion of cervical smears. b. In the vast majority of cases, HCG are benign. c. ECA were only observed in cases with HCG. This observation is consistent with the hypothesis that the presence of HCG in Pap tests most often represents adequate sampling of the transformation zone, thus increasing the chances of detecting an epithelial cell abnormality. d. Only a few cases with HCG were associated with a serious ECA, but careful scrutiny of all HCG appears warranted to avoid the potential diagnostic pitfall of a significant false negative interpretation.

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“…Conversely, well‐differentiated EMCa may not be correctly identified owing to lack, reduction, or altered quality of background watery diathesis 78, 101. Saad et al and Schorge et al have shown that majority of lesions with AGC‐EM interpretation on LBP are of EM origin (neoplastic and non‐neoplastic) compared to CPS 102…”

Section: Atypical Em Cellsmentioning

confidence: 99%

Gynecologic cytology on conventional and liquid‐based preparations: A comprehensive review of similarities and differences

Hoda

Loukeris

Abdul‐Karim

2012

Diagnostic Cytopathology

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Liquid-based preparations (LBPs) have largely replaced conventional Papanicolaou smears (CPS) for cervical samples in the United States and in many other industrialized countries. The two FDA-approved LBP currently in use include ThinPrep (TP), (Hologic Inc., Bedford, MA) and SurePath (SP), (BD Diagnostic, Burlington, NC). Split-sample and direct-to-vial studies have shown that LBPs show an overall improvement in sample collection and processing, reduce artifacts that interfere in diagnosis, are more sensitive, can be utilized for ancillary tests and are a cost-effective replacement for CPS. Comparative analyses of diagnostic accuracy indicate that LBPs perform at least as well as CPS. However, the added advantages of standardized, automated preparations and screening, reduced unsatisfactory rate, improved specimen adequacy and ability to perform human papillomavirus (HPV) test, are enough to continue use of LBP. The cytologic features in LBP are similar to CPS with subtle differences, particularly in background information. There are also subtle differences between the two LBPs, SP and TP, which are reflective of different sampling devices, collection media, and processing techniques. Architecturally, LBP shows smaller cell clusters and sheets and more dyscohesion. Cytologically, enhanced nuclear features and smaller cell size are more prominent. Advances in liquid-based Papanicolaou's (Pap) test have lead to well-defined patient management guidelines by the American Society for Colposcopy and Cervical Pathology. Herein, we review these aspects of Pap test including, morphology, automation, ancillary tests (HPV and immunochemistry), pertinent QA/QC monitors, patient management guidelines, and review of pertinent literature.

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Clinical Significance of a Cytologic Diagnosis of Atypical Glandular Cells, Favor Endometrial Origin, in Pap Smears

Cited by 15 publications

References 0 publications

Clinical Significance of Atypical Glandular Cells by the 2001 Bethesda System in Cytohistologic Correlation

Clinical Significance of Atypical Glandular Cells by the 2001 Bethesda System in Cytohistologic Correlation

Untitled

Gynecologic cytology on conventional and liquid‐based preparations: A comprehensive review of similarities and differences

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