The role of Pap smear in the diagnostics of endocervical adenocarcinoma

Pulkkinen, Johanna; Huhtala, Heini; Kholová, Ivana

doi:10.1111/apm.13115

Cited by 6 publications

(6 citation statements)

References 34 publications

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“…In addition, crowded fragments with scant cellular cytoplasm and at least one architectural feature (rosettes, feathering, palisading cell borders, papillary groups) were more commonly encountered among samples with good diagnostic consensus. Marked nuclear enlargement and nuclear pleomorphism were a combination of features associated with adenocarcinoma and AIS also in previous studies [13,31,32]. Similar features of increased nuclear to cytoplasmic ratio and cells occurring in sheets and strips with cell crowding and nuclear overlap have also earlier been described [31].…”

Section: Discussionsupporting

confidence: 82%

“…A randomly selected subset of 167 conventional Pap smear slides from a previously analyzed cohort from the Pathology department of Fimlab Laboratories Oy was studied [13]. The slides represented Pap smears from 27 patients with endocervical adenocarcinomas (EAC), 23 patients with adenocarcinomas in situ (AIS), and 28 patients with high-grade squamous lesions (HSIL).…”

Section: Methodsmentioning

confidence: 99%

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Endocervical Cytology: Inter- and Intra-Observer Variability in Conventional Pap Smears

Pulkkinen¹,

Huhtala²,

Krogerus³

et al. 2022

Acta Cytologica

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Introduction: Although the cytological diagnostic criteria for cervical squamous and glandular lesions are established by the Bethesda System for Reporting Cervical Cytology, the reproducibility of the diagnosis of these lesions has been shown to be variable in previous studies. At best, occasional good kappa (κ) values were reached both inter- and intra-observerly. Generally, consensus on high-grade lesions has been better compared to milder changes. Methods: Altogether, 167 conventional Pap smears from 50 patients with histologically confirmed endocervical adenocarcinomas (EAC) and adenocarcinomas in situ (AIS) and from 28 patients with histologically proven high-grade intraepithelial lesions were analyzed by four cytopathologists. Twenty of the smears were later re-evaluated by the same cytopathologists. κ-values between cytopathologists in the categories of squamous versus glandular, negative for intraepithelial lesion or malignancy (NILM), atypical, and preneoplastic/neoplastic were calculated. The diagnostic Pap smears of EAC and AIS with best and worst consensus between observers were then morphologically analyzed. Results: The reproducibility ranged from poor to substantial. The overall κ-values between the four cytopathologists were 0.412, 0.314, 0.272, and 0.082, respectively, in the categories of preneoplastic/neoplastic, squamous versus glandular, NILM, and atypical. Overall intra-observer κ-values were correspondingly 0.491, 0.616, 0.345, and 0.241. In the diagnostic smears of AIS and EAC, the nuclear size >2 times the normal and nuclear pleomorphism were the commonest features associated with good diagnostic consensus and the lack of nuclear enlargement and degenerative changes were associated with poor consensus. Conclusions: The reproducibility of preneoplasia/neoplasia diagnoses was better than that of atypia and NILM both in the inter- and intra-observer part in this study. In the smears from AIS and EAC patients, general neoplasia-associated features were more common in samples with good agreement by the four cytopathologists of the neoplastic nature and the endocervical origin of the lesion.

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Section: Discussionsupporting

confidence: 82%

Section: Methodsmentioning

confidence: 99%

Endocervical Cytology: Inter- and Intra-Observer Variability in Conventional Pap Smears

Pulkkinen¹,

Huhtala²,

Krogerus³

et al. 2022

Acta Cytologica

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“…The 45 Pap smears were initially diagnosed as glandular atypia by general pathologists in routine practice and, in the present study, were blindly reviewed by two cytopathologists with 25 and 10 years of respective experience in cytopathology. The Pap smears were analysed to search for 38 different cytological features described earlier [17] and consisting of background, cellular, nuclear, and architectural features (Table 1). The findings reported in the study are based on the consensus of the two cytopathologists.…”

Section: Methodsmentioning

confidence: 99%

“…The cytomorphological features predicting AIS and endocervical adenocarcinoma (EAC) have previously been studied and described [7,[14][15][16][17]. The features associated with benign endocervical changes have been less well documented, although reactive and reparative cellular changes have been recognized as a significant source of false-positive Pap smears [1,18].…”

Section: Introductionmentioning

confidence: 99%

False-Positive Atypical Endocervical Cells in Conventional Pap Smears: Cyto-Histological Correlation and Analysis

Pulkkinen,

Huhtala,

Kholová

2023

Acta Cytologica

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Introduction: Endocervical glandular atypia is relatively rarely diagnosed by Pap smears. A significant proportion of follow-up histological samples show no premalignant or malignant lesions. The observed cytomorphological findings in premalignant glandular lesions overlap with histologically proven reactive lesions. Methods: A total of 45 conventional Pap smears diagnosed as atypical endocervical cells, not otherwise specified (AEC, NOS) with human papillomavirus (HPV) status available were blindly evaluated in a search for 38 cytomorphological features representing background, architectural, cellular and nuclear features. Of the cases, 30 represented histologically proven benign changes, and 15 represented histologically proven adenocarcinoma in situ (AIS) or endocervical adenocarcinoma (EAC) cases. The benign biopsies were re-evaluated, and the associations of the cytomorphological features or combinations of them with specific histological features and entities were statistically examined. Results: The most frequent histological findings in the benign group were squamous metaplasia, inflammation, tubal metaplasia and microglandular hyperplasia. The statistical analysis revealed cytological features associated with squamous metaplastic changes, inflammation and microglandular hyperplasia. Unfortunately, no cytomorphological feature was sufficiently specific to confidently leave the lesion without follow-up and histological correlation. Degeneration and nuclear crowding were the most salient features that distinguished the instances of glandular atypia with benign follow-up histology from those with histologically proven AIS or EAC (26.7% vs. 60.0%, P= 0.030 and 50.0% vs 86.7%, P = 0.017). Conclusion: Additional methods besides cytomorphology are required to reliably distinguish smears with AEC, NOS harbouring only benign histological changes from those exhibiting endocervical glandular malignancy.

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“…В мировой практике цитологический метод диагностики эндоцервикальных аденокарцином используется достаточно широко. Об этом свидетельствуют появившиеся работы, касающиеся не только диагностики, но и возможностей дифференцирования типов эндоцервикальных аденокарцином по цитологическим препаратам, о чем свидетельствуют научные статьи [26][27][28][29][30].…”

Section: опухоли женской репродуктивной системы Tumors Of Female Repr...unclassified

Endocervical adenocarcinomas. Cytological, histological, and molecular diagnostics

Григорук

Moskvina

Tsoy

et al. 2022

Opuholi ženskoj reproduktivnoj sistemy

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This study was undertaken to analyze the effectiveness of cytological diagnostics of endocervical adenocarcinomas. We compared conventional liquid-based cytology, histology, immunohistochemistry, and molecular testing. A total of 25 endocervical adenocarcinomas, including endocervical adenocarcinomas in situ, were diagnosed using cytological methods over a year. Liquid-based cytology ensured better detection of glandular differentiation signs than conventional cytology. After molecular testing for human papillomavirus (HPV), we performed retrospective analysis of cytological characteristics of all endocervical adenocarcinomas (n = 15).We identified specific cellular characteristics of HPV-associated typical and mucinous adenocarcinomas. We also observed 1 case of non-HPV-related clear-cell and 1 case of non-HPV-related mesonephral adenocarcinoma.Our findings suggest that endocervical adenocarcinomas are a heterogeneous group of tumors. Endocervical adenocarcinomas accounted for 10.7 % of all primary cervical carcinomas (n = 214). Eighty percent of all endocervical adenocarcinomas were HPV-related, whereas the remaining 20 % were HPV-negative. We found no cytological differences between invasive endocervical adenocarcinomas and adenocarcinomas in situ.Mutations detected in some of the patients are an important diagnostic criterion that specifies whether the tumor is rare.

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The role of Pap smear in the diagnostics of endocervical adenocarcinoma

Cited by 6 publications

References 34 publications

Endocervical Cytology: Inter- and Intra-Observer Variability in Conventional Pap Smears

Endocervical Cytology: Inter- and Intra-Observer Variability in Conventional Pap Smears

False-Positive Atypical Endocervical Cells in Conventional Pap Smears: Cyto-Histological Correlation and Analysis

Endocervical adenocarcinomas. Cytological, histological, and molecular diagnostics

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