Pathologic findings in women with atypical glandular cells on Pap test

Dhamne, Sagar; Soundars, Esther; Zarrin-Khameh, Neda

doi:10.1016/j.jasc.2015.09.213

Cited by 3 publications

(5 citation statements)

References 14 publications

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“…These results suggest that continued education and training regarding AGC are needed. Our results also support poor reproducibility in deciding whether the atypical cells in question are glandular versus squamous, as is consistent with published studies finding that a subset of morphologic AGC mark squamous lesions with metaplastic/glandular-type cytoplasmic features [15,17,29]. Cytotechnologists and pathologists working as primary screeners are on the frontline of screening and they are the key players identifying AGC.…”

Section: Discussionsupporting

confidence: 89%

“…In contrast, studies by Schnatz et al [15], Jiang et al [16], Dhamne et al [17] found that the most common malignancy after an AGC diagnosis is endometrial AC. Dhamne et al [17] and Jiang et al [16] also observed a higher proportion of endometrial carcinoma after AGC diagnosis in women over 48 and 51 years of age, respectively, while younger women were more likely to have squamous carcinoma on follow-up [16,17]. While these age guidelines are helpful on a population basis, there are always cases that break the rules; for example, above we described a case of well-differentiated endometrioid AC of the endometrium in a 29-year-old woman (Fig.…”

Section: Discussionmentioning

confidence: 89%

“…A large study of over 3 million women in Sweden tracking cervical cancer as an outcome found that AGC is most closely linked to endocervical AC and is secondarily a marker for squamous cell carcinoma or noncervical glandular lesions [8]. In contrast, studies by Schnatz et al [15], Jiang et al [16], Dhamne et al [17] found that the most common malignancy after an AGC diagnosis is endometrial AC. Dhamne et al [17] and Jiang et al [16] also observed a higher proportion of endometrial carcinoma after AGC diagnosis in women over 48 and 51 years of age, respectively, while younger women were more likely to have squamous carcinoma on follow-up [16,17].…”

Section: Discussionmentioning

confidence: 99%

“…The present study is novel due to a focus on AGC diagnosis classified by likely clinical management using the subtype classifications of AGC published in the 2014 TBS. Our manner of classifying cases takes some of the pressure off of deciding whether an atypical cell is glandular versus squamous, as what matters most is the identification of cytologic atypia leading to the proper next steps [3,[15][16][17]27].…”

Section: Discussionmentioning

confidence: 99%

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Atypical Glandular Cells: Interobserver Variability according to Clinical Management

et al. 2018

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Objective: The 2014 Bethesda System diagnostic criteria for atypical glandular cells (AGC) aids in classification of atypical cells in cervical cytology. There is limited literature regarding reproducibility and interobserver variability in the application of the 2014 AGC criteria. Our aim is to assess the interobserver variability of AGC with a focus on how diagnostic categories link with guideline-driven management. Study Design: Three observers re-reviewed 51 previously diagnosed AGC Papanicolaou tests. The diagnoses were categorized as follows: (1) according to guideline-specified management, and (2) as glandular vs. squamous lesions. The κ statistic was used to evaluate interobserver agreement. Results: The interobserver variability per guideline management by weighted 2-observer κ ranged from 0.009 to 0.530, with half of the interobserver pairings meeting the threshold for at least fair-moderate agreement. For categorization as glandular, squamous, or both, unweighted κ yielded at best fair interobserver agreement (κ = 0.250) in 1 pairing, with low κ scores in the remainder of reviewer pairs (range 0.015–0.152). Conclusions: There is significant interobserver variability in the diagnosis of AGC. The AGC cases when divided by clinical management had fair-moderate interobserver agreement, suggesting that diagnostic variability likely has a real effect on patient care. This diagnostic uncertainty should be understood by cytologists and clinicians.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Atypical Glandular Cells: Interobserver Variability according to Clinical Management

et al. 2018

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“…The low reproducibility of abnormalities in the glandular epithelium is due to several factors, including difficulty in differentiating whether there is an abnormality in the glandular epithelium or carcinoma [22,23]. According Bansal et al [24], the low reproducibility may be due to the smaller number of glandular cells present in the smear of the cytopathologic examination, requiring a κ 2007, 0.80 (between 0.61 and 0.80 -good concordance); 2017, 0.90 (between 0.81 and 0.99 -excellent concordance); unsat., unsatisfactory; NILM, negative for intraepithelial lesion or malignancy; ASC, atypical squamous cells; ASC-US, ASC -undetermined significance; ASC-H, ASC -cannot exclude a high-grade squamous intraepithelial lesion (HSIL); LSIL, low-grade squamous intraepithelial lesion; HSIL/Ca, HSIL/HSIL with features suspicious for invasion/squamous cell carcinoma; AGC/AIS, atypical endocervical cells -not otherwise specified/atypical endocervical cells -favor neoplastic/endocervical adenocarcinoma in situ.…”

Section: Discussionmentioning

confidence: 99%

Performance of Laboratories after 10 Years of Participating in External Quality Monitoring in Cervical Cytology

et al. 2019

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Objective: To evaluate the performance of laboratories accredited by the National Health System that perform cytopathology examination of the uterine cervix after 10 years of participation in external quality monitoring (eQM). Study Design: Seven laboratories were assessed in this study. To assess the concordance of the representation of epithelia and results, 6,536 examinations (3,433 in 2007 and 3,103 in 2017) were reviewed. Statistical analysis was performed using the κ coefficient as well as the χ 2 and the Fisher exact test (p < 0.05). Results: All laboratories showed adequate infrastructure and internal quality monitoring. Regarding the representation of the epithelia, the concordance remained excellent (κ between 0.84 and 0.94). In 2007, 26 false-negative results (FN), 157 false-positive results (FP), and 79 delays in clinical conduct (DCC) were identified (κ = 0.80). In 2017, 24 FN, 42 FP, and 38 DCC were identified (κ = 0.90). Five laboratories showed improvement in concordance from 2007 to 2017. We observed significant improvement in cytomor-phological criteria of the results: atypical squamous cells of undetermined significance (p < 0.001), atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (p < 0.016), and low-grade squamous intraepithelial lesion (p < 0.001). We also observed a considerable improvement in the results of cellular abnormalities in glandular epithelium (p < 0.0504). Conclusions: Ten years after the implementation of eQM, improvements in the concordance of results were observed as well as reductions in FN, FP, and DCC in all laboratories monitored.

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Do High Rates of Atypical Glandular Cells Correlate With Higher Incidence of Disease in a Large Safety Net Hospital

Kuhn

Finneran

Kohut

et al. 2020

J Low Genit Tract Dis

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Objective The aim of the study was to describe the incidence and correlates of atypical glandular cell (AGC) Pap tests in a low socioeconomic status, underserved population. Materials and Methods Medical records of patients with AGC Pap tests at a single institution were reviewed from January 2013 to August 2019. Baseline characteristics were extracted including age, body mass index, birth control, abnormal uterine bleeding, and human papillomavirus (HPV). All colposcopy and endometrial biopsies were classified into negative/low-risk (polyps, tubular metaplasia, microglandular hyperplasia, cervical intraepithelial neoplasia 1) and high-risk (HR) lesions (cervical intraepithelial neoplasia 2/3, adenocarcinoma in situ, endometrial hyperplasia, cervical cancer, endometrial cancer). Logistic regression identified significant associations. Sixty-eight randomly selected AGC cytology slides from the cohort and 32 non-AGC slides outside the cohort were blindly reviewed by 6 pathologists. Fleiss κ interrater agreement was assessed. Results Seven hundred forty patients with AGC Pap tests were identified (0.8% of all Pap tests performed during this time). After excluding for incomplete data, 478 patients were included. Sixty-three patients had HR lesions (13.3%). Patients with HR lesions had increased odds of abnormal uterine bleeding (odds ratio = 4.32, p < .001) and HPV positivity (odds ratio = 10.89, p < .001) when compared with patients with low-risk lesions. The κ agreement was 0.21 for all cases and 0.18 for AGC alone. Conclusions This population falls within the national averages for AGC Pap tests. There was an increased risk of HR lesions in patients with abnormal uterine bleeding and HPV positivity. The rate of HR lesions among AGC Pap tests was at the lower end of values in the literature. After blinded pathologist review, interobserver κ agreement was low for AGC Pap tests.

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Pathologic findings in women with atypical glandular cells on Pap test

Cited by 3 publications

References 14 publications

Atypical Glandular Cells: Interobserver Variability according to Clinical Management

Atypical Glandular Cells: Interobserver Variability according to Clinical Management

Performance of Laboratories after 10 Years of Participating in External Quality Monitoring in Cervical Cytology

Do High Rates of Atypical Glandular Cells Correlate With Higher Incidence of Disease in a Large Safety Net Hospital

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