Can glandular lesions be diagnosed in pap smear cytology?

Abstract

Many reports have been published on the accuracy of the cervical vaginal smear for squamous lesions, and the literature contains fewer reports on the accuracy of the cervical vaginal smear for glandular lesions. The sensitivity of glandular lesion diagnosis depends on the subtype of lesion. The diagnostic sensitivity is highest for invasive endocervical adenocarcinoma and lowest for endometrial adenocarcinoma. The ability of some of the Bethesda system categories for glandular lesions to describe what they purport to describe is questionable. The Bethesda system categories of adenocarcinoma accurately classify adenocarcinomas. The Bethesda System category of atypical glandular cells of undetermined significance (AGUS) is a misnomer. Although many cases of adenocarcinoma in‐situ are placed in this category, follow‐up of patients with AGUS show that the majority of patients with clinically significant lesions have squamous dysplasias. Other categories of AGUS, such as AGUS favor endometrial origin, are more appropriately named and encompass endometrial lesions which are either neoplastic or non‐neoplastic. Diagn. Cytopathol. 23:127–133, 2000. © 2000 Wiley‐Liss, Inc.

Comparative sensitivities of ThinPrep and Papanicolaou smear for adenocarcinoma in situ (AIS) and combined AIS/high-grade squamous intraepithelial lesion (HSIL): Comparison with HSIL

“…[17][18][19] Other studies focus on the detection of atypical glandular cells of undetermined significance, [20][21][22][23][24] an imprecise term, which is recognized to yield more high-grade squamous lesions than high-grade endocervical glandular lesions. 22,[25][26][27] The concurrent presence of cells from an HSIL did not increase the sensitivity of cervical cytology; in fact, cytologists were less likely specifically to recognize a high-grade glandular lesion. This finding was true for both the PS group and the TP group.…”

The HPV Cellular Transactivator Brn-3a Can Be Used to Predict Cervical Adenocarcinoma and Squamous Carcinoma Precancer Lesions in the Developed and Developing Worlds

“…This is because Brn-3a transactivates the HPV URR and the transcribed EORF E6 product is crucial for cervical transformation [27–29]. For instance, cervical carcinoma precursor lesions such as those of SCC and AC, which are frequently situated in the innermost regions of the cervix [6, 7], where it is always difficult to exfoliate cells for diagnosis using classical tools [6, 7, 34], could potentially be diagnosed using the mRNA levels of Brn-3a as well as HPV. This is because the oncogenic gene products of HPV, E6, and E7 depend on the activity of specific cellular transactivators such as Brn-3a for its transactivation [6, 18, 30–32].…”

Atypical Glandular Cells and Endocervical Adenocarcinoma in Situ of the Uterine Cervix

“…13 Despite these advances in the recognition of this lesion in cytologic samples, a recent study reports that this interpretation category remains problematic and suffers from significant interobserver subjectivity in practice. [15][16][17] Cytologically, endocervical AIS is characterized by the presence of variably sized hyperchromatic crowded groups and tissue fragments in a generally clean background. 6,12,18,19 Peripheral palisading of the glandular cells, gland openings within the sheets, and rosette arrangements with central lumens may also be observed.…”

“…12 As with the category of AIS, studies have shown that the AGC interpretation category suffers from problems with interobserver reproducibility. [15][16][17]34,35 …”