Histologic follow-up results in 662 patients with Pap test findings of atypical glandular cells: Results from a large academic womens hospital laboratory employing sensitive screening methods

BACKGROUND:The study documents histopathologic outcomes and high‐risk (hr) human papillomavirus (HPV) test results in a large cohort of patients with high‐grade squamous intraepithelial lesion (HSIL) liquid‐based cytology (LBC) Pap test results.METHODS:A total of 352 patients with HSIL results (338 cervical and 14 vaginal) who had hrHPV testing and 290 patients with biopsy follow‐up were studied. hrHPV detection rates were compared at different ages, with or without an endocervical/transformation zone sample (EC/TZS), and for cervical and vaginal HSIL Pap smears. Histopathologic follow‐up findings were also compared. hrHPV‐negative HSIL slides were re‐evaluated in a blinded manner.RESULTS:A total of 325 of 338 (96.2%) cervical HSIL and 12 of 14 (87.5%) vaginal HSIL tested hrHPV‐positive. A total of 271 of 281 (96.4%) EC/TZS‐positive cervical HSIL and 54 of 57 (94.7%) EC/TZS‐negative cervical HSIL tested hrHPV‐positive. The percentage of hrHPV‐positive HSIL declined slightly with increasing age. 197 of 273 (72.3%) hrHPV‐positive cervical HSIL had histopathologic cervical intraepithelial neoplasia (CIN) 2/3+ follow‐up, including 8 squamous carcinomas, compared with 4 of 12 (33.3%) hrHPV‐negative HSIL with CIN2/3 (no carcinomas). 167 of 241 (69.2%) EC/TZS‐positive HSIL had CIN2/3+ follow‐up, compared with 34 of 44 (77.3%) EC/TZS‐negative HSIL. Equivocal HSIL morphology characterized some HPV‐negative HSIL without CIN2/3+ follow‐up.CONCLUSIONS:hrHPV was detected in LBC vials from 96.2% of 338 cervical HSIL and 85.7% of 14 vaginal HSIL. CIN2/3+ was significantly more likely with hrHPV‐positive cervical HSIL than with hrHPV‐negative cervical HSIL. Presence or absence of an EC/TZS did not significantly impact HSIL hrHPV or CIN2/3+ rates. Some hrHPV‐negative HSIL cases may represent HSIL cytologic mimics. Cancer (Cancer Cytopathol) 2011;. © 2011 American Cancer Society.

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“…The reporting profile of the laboratory is documented in numerous recent publications. [23][24][25][26][27][28][29][30][31] Original Article…”

Section: Case Selection and Cytologic Methodsmentioning

confidence: 99%

Histopathologic follow‐up and human papillomavirus DNA test results in 290 patients with high–grade squamous intraepithelial lesion papanicolaou test results

Gao

Austin

Zhao

2011

Cancer Cytopathology

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“…Additional endometrial sampling is recommended in women 35 years of age or older, and in women at risk of endometrial neoplasia. In the literature, the incidence of significant lesion in women with AGC-NOS varies from 5% to 33% (Haidopoulos et al, 2005;DeSimone et al, 2006;Behtash et al, 2007;Westin et al, 2008;Adhya et al, 2009;Schnatz et al, 2009;Zhao et al, 2009) as compared with 41%-70% in women with AGC-FN smears (Haidopoulos et al, 2005;DeSimone et al, 2006;Westin et al, 2008;Adhya et al, 2009;Schnatz et al, 2009). Extragenital malignant lesions were found in less than 1% of women with AGC cytology (Zhao et al, 2009).…”

Section: Atypical Glandular Cellsmentioning

confidence: 99%

Histopathological Outcomes of Women with Abnormal Cervical Cytology: a Review of Literature in Thailand

Kietpeerakool¹,

Tangjitgamol²,

Srisomboon³

2014

Asian Pacific Journal of Cancer Prevention

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Asian Pac J Cancer Prev, 15 (16), 6489-6494 IntroductionCervical cancer remains the major health problem in Thailand and many other developing countries. This is mainly because of failure to initiate or sustain effective screening strategy. In recent population-based cancer registries, the highest incidence of cervical cancer in Thailand was noted in Chiang Mai with an average agestandardized incidence rate (ASR) of 28.9 per 100000, followed by Lampang (ASR, 22.4) and Bangkok (ASR, 20.9) (Moore et al., 2010).Although high-risk Human Papillomavirus (HR-HPV) test and HPV genotyping have certain role in cervical cancer screening nowadays, these tests are not widely available in developing countries. Cervical cytology is still the principal screening method. Subsequent management of abnormal cervical cytology to detect underlying cervical lesions is also important. Generally, management of abnormal cervical cytology depends on the risk of encountering high-grade cervical disease. However, the risks of high-grade cervical disease encountered in abnormal cervical cytology may vary among different regions of the world and across the country. Therefore, information regarding the incidence of significant cervical disease from different areas or populations is crucial for designing and implementing area-specific management approach. This review was conducted to evaluate the incidence of high-grade cervical diseases among Thai AbstractCervical cytology remains the principal screening method to detect pre-invasive and invasive cervical lesions. Management of abnormal cervical cytology depends on the risk of encountering a significant cervical lesion or high-grade cervical disease. These risks may vary in different areas across the country. Thus, determining the rate of significant cervical lesion associated with each type of abnormal cervical cytology in each area is of critical importance for designing area-specific management approach. This review was conducted to evaluate the rate of high-grade cervical disease among Thai women with abnormal cervical cytology. A relatively high incidence of underlying significant lesions including invasive disease was demonstrated even in those having only minimal smear abnormality. This baseline information is crucial and must be taken into consideration in management of women with abnormal cytological screening to achieve the goals of comprehensive cervical cancer control in Thailand.

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“…9 Several studies have demonstrated that AEC may be associated with premalignant or malignant cervical lesions but most have been limited by short follow-up periods and/or relatively small numbers of cases. 7,[10][11][12] Furthermore, the risk of significant pathology has not always been correlated with age, prior smear history, presence of endocervical cells in preceding cytology samples or the socio-economic status of the patient. In the present study, we have investigated the potential relationship between these factors and the risk of high-grade cervical dysplasia and gynaecological malignancies in women with a cytological diagnosis of AEC in Western Australia (WA) over a seven-year period.…”

Section: Introductionmentioning

confidence: 99%

Risk of high‐grade cervical dysplasia and gynaecological malignancies following the cytologic diagnosis of atypical endocervical cells of undetermined significance: A retrospective study of a state‐wide screening population in Western Australia

Munro¹,

Williams

Semmens

et al. 2015

Aust NZ J Obst Gynaeco

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Background: In 2006, Australia adopted a revised cervical cytology terminology system, known as the Australian Modified Bethesda System (AMBS). One substantial change in the AMBS was the introduction of the diagnostic category of atypical endocervical cells (AEC) of undetermined significance. Aim: The aim of this study was to investigate the incidence of histologically confirmed high-grade cervical dysplasia (cervical intra-epithelial neoplasia (CIN) grades 2 and 3 and adenocarcinoma in situ (ACIS)), cervical carcinoma and endometrial carcinoma in women presenting with AEC on cervical cytology. Methods: A seven-year retrospective study examining clinical outcomes of women with AEC on a screening cervical smear. Cytology and histology results were extracted from the Western Australia Cervical Screening Registry, and time-toevent analysis was used to predict the odds of having or developing in situ and invasive neoplasia. Results: AEC was reported in index smears from 0.093% (584/622754) women during the study period. No follow-up was available in 35 AEC cases. Sixty-five of the remaining 549 women (11.8%) had, or developed, high-grade cervical dysplasia within five years of their index AEC diagnosis. Endometrial cancer was diagnosed in 21 women and cervical cancer in four women during the follow-up period. Conclusion: Cytologic demonstration of AEC requires careful gynaecologic evaluation, particularly in younger women who may be found to have either high-grade squamous (CIN) or glandular (ACIS) lesions, while in older women, the possibility of endometrial neoplasia needs to be considered.

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Histologic follow-up results in 662 patients with Pap test findings of atypical glandular cells: Results from a large academic womens hospital laboratory employing sensitive screening methods

Cited by 141 publications

References 54 publications

Histopathologic follow‐up and human papillomavirus DNA test results in 290 patients with high–grade squamous intraepithelial lesion papanicolaou test results

Histopathologic follow‐up and human papillomavirus DNA test results in 290 patients with high–grade squamous intraepithelial lesion papanicolaou test results

Histopathological Outcomes of Women with Abnormal Cervical Cytology: a Review of Literature in Thailand

Risk of high‐grade cervical dysplasia and gynaecological malignancies following the cytologic diagnosis of atypical endocervical cells of undetermined significance: A retrospective study of a state‐wide screening population in Western Australia

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