Identification of Atypical Glandular Cells in Pap Smears: Is It a Hit and Miss Scenario?

Ajit, Dulhan; Gavas, Sonali; Joseph, Stonny; Rekhi, Bharat; Deodhar, Kedar; Kane, Shubhada

doi:10.1159/000342744

Cited by 13 publications

(12 citation statements)

References 69 publications

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“…3 a, b). Similarly, another case was reported as invasive SCC on cytology, which showed [8] 21,854 83 0.4 Gutman et al [9] 11,800 45 0.38 Crasta et al [10] 10,787 19 0.17 Adhya et al [11] 18,376 65 0.35 Ajit et al [12] 22,618 74 0.32 Jeng et al [13] 51,419 49 0.09 Scheiden et al [14] 522 adenosquamous carcinoma on histopathology. This was due to the presence of only malignant squamous cells on cytology ( Fig.…”

Section: Discussionmentioning

confidence: 95%

“…The premalignant and malignant conditions range from squamous CIN to AIS of the cervix, and complex endometrial hyperplasia with or without atypia. Malignancies of the upper and lower genital tract and, rarely, abdominal or distant nonreproductive organs can also present as AGC on Pap smears [3,[5][6][7]12].…”

Section: Discussionmentioning

confidence: 99%

“…In most studies [4,6,7,9,12] , AGC prove to be squamous epithelial abnormalities on histopathology, mainly the high-(HSIL) and low-grade squamous intraepithelial lesions (9-54%) [3] . In our study, 16.7% of cases were HSIL (CIN II/III).…”

Section: Discussionmentioning

confidence: 99%

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The Significance of Glandular Cells on Conventional Cervicovaginal Smears: Experience from a Tertiary Care Hospital in Coastal India

Suresh

Kini

Minal³

et al. 2017

Acta Cytologica

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Introduction: Glandular lesions of the female genital tract (FGT) are quite uncommon compared to squamous lesions. Their cytological diagnosis is difficult because of their architectural and cytological complexity, as well as the lack of experience of many cytopathologists in this field. The aim of this study was to determine the significance of Papanicolaou (Pap) smears in the diagnosis of glandular FGT lesions. Methodology: All Pap smears reported during the period of January 2012 to December 2013 were retrieved. Cytohistopathological correlation was done. Results: Among 7,609 Pap smears, squamous epithelial abnormalities were seen in 110 cases (1.5%) and glandular cell abnormalities in 32 cases (0.42%). Among the glandular abnormalities, we encountered 18 cases of atypical glandular cells (AGC) not otherwise specified, 4 cases of endocervical-type AGC and 4 cases favoring neoplastic-type AGC, 2 cases of adenocarcinoma of the endocervical type, 3 cases of adenocarcinoma of the endometrial type, and 1 case of extrauterine adenocarcinoma. Histopathological correlation was available in 12 cases (37.5%). Eighty-three percent showed premalignant or malignant lesions on histopathology. Conclusion: As glandular epithelial lesions are associated with premalignant and malignant FGT lesions, in patients with cytological diagnosis of glandular epithelial abnormalities, it is mandatory to undergo colposcopic examination with endocervical and endometrial curettage.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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The Significance of Glandular Cells on Conventional Cervicovaginal Smears: Experience from a Tertiary Care Hospital in Coastal India

Suresh

Kini

Minal³

et al. 2017

Acta Cytologica

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“…[ 7 ] There have been numerous studies addressing the clinical significance of patients with AGC in general. [ 8 9 10 11 12 13 14 15 16 17 ] Histologic follow-up of women with an AGC interpretation has revealed a spectrum of lesions ranging from benign to malignant neoplasm and from squamous dysplasia to adenocarcinoma of the endocervix or endometrium. [ 9 16 18 19 ] The 2012 American Society of Colposcopy and Cervical Pathology (ASCCP) Guideline recommends endometrial and endocervical sampling for all women with a diagnosis of AEM.…”

Section: Introductionmentioning

confidence: 99%

Atypical endometrial cells and atypical glandular cells favor endometrial origin in Papanicolaou cervicovaginal tests: Correlation with histologic follow-up and abnormal clinical presentations

et al. 2014

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The 2001 Bethesda system recommends further classifying atypical glandular cells (AGCs) as either endocervical or endometrial origin. Numerous studies have investigated the clinical significance of AGC. In this study, we investigated the incidence of clinically significant lesions among women with liquid-based Papanicolaou cervicovaginal (Pap) interpretations of atypical endometrial cells (AEMs) or AGC favor endometrial origin (AGC-EM). More importantly, we correlated patients of AEM or AGC-EM with their clinical presentations to determine if AEM/AGC-EM combined with abnormal vaginal bleeding is associated with a higher incidence of significant endometrial pathology. All liquid-based Pap tests with an interpretation of AEM and AGC-EM from July, 2004 through June, 2009 were retrieved from the database. Women with an interpretation of atypical endocervical cells, AGC, favor endocervical origin or AGC, favor neoplastic were not included in the study. The most severe subsequent histologic diagnoses were recorded for each patient. During this 5-year period, we accessioned 332,470 Pap tests of which 169 (0.05%) were interpreted as either AEM or AGC-EM. Of the 169 patients, 133 had histologic follow-up within the health care system. The patients ranged in age from 21 to 71 years old (mean 49.7). On follow-up histology, 27 (20.3%) had neoplastic/preneoplastic uterine lesions. Among them, 20 patients were diagnosed with adenocarcinoma (18 endometrial, 1 endocervical, and 1 metastatic colorectal), 3 with atypical endometrial hyperplasia, and 4 with endometrial hyperplasia without atypia. All patients with significant endometrial pathology, except one, were over 40 years old, and 22 of 25 patients reported abnormal vaginal bleeding at the time of endometrial biopsy or curettage. This study represents a large series of women with liquid-based Pap test interpretations of AEM and AGC-EM with clinical follow-up. Significant preneoplastic or neoplastic endometrial lesions were identified in 20.3% of patients. Patients with Pap test interpretations of AEM or AGC-EM and the clinical presentation of abnormal vaginal bleeding should be followed closely.

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“…The diagnosis of AGC demonstrates high interobserver variability [17-19]. Across publications, the cytologic diagnostic terminologies adhered to differing recommendations (various editions of Bethesda or other reporting guidelines) and patient management was not standardized, presenting challenges in comparing conclusions.…”

Section: Discussionmentioning

confidence: 99%

Glandular Cell Abnormalities on SurePath Preparations: A Retrospective Review with Cytology-Histology Correlations

Fischer¹,

Cormier²

2018

Acta Cytologica

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Objective: Detecting glandular lesions is challenging by all Pap test methodologies. As the availability of data on identifying glandular abnormalities by SurePath is scarce, we investigated the detection rates and the correlation with histology follow-up. Study Design: A total of 105,927 cases (SurePath and conventional) were searched for the diagnosis of atypical glandular cells or higher glandular abnormalities (AGC+) with the corresponding histologic diagnosis. The associations between the Pap test methods and diagnostic categories were assessed by χ² test. Results: Overall, 0.32% of SurePath (159/49,375) and 0.29% of conventional (164/56,552) cases showed AGC+ (p = 0.38). Histology confirmed significant abnormalities in 42 versus 53.5% of the cases, respectively (p = 0.064); 72.7% (SurePath) versus 65.2% (conventional) of these were glandular in nature (p = 0.37). The diagnosis of neoplasia (favored or definitive) showed malignancy on follow-up in 100% of SurePath cases (12/12). In contrast, 82.1% of these conventional cases disclosed premalignant or malignant lesions by histology (p = 0.12). Conclusions: AGC+ cases showed higher prevalence on SurePath preparations. Conventional cases had more abnormalities on follow-up, while glandular lesions represented a higher proportion of abnormal histologies following SurePath AGC+s. The positive predictive value of favored or definite neoplasia was higher in SurePath cases. Overall, these differences were not statistically significant.

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Identification of Atypical Glandular Cells in Pap Smears: Is It a Hit and Miss Scenario?

Cited by 13 publications

References 69 publications

The Significance of Glandular Cells on Conventional Cervicovaginal Smears: Experience from a Tertiary Care Hospital in Coastal India

The Significance of Glandular Cells on Conventional Cervicovaginal Smears: Experience from a Tertiary Care Hospital in Coastal India

Atypical endometrial cells and atypical glandular cells favor endometrial origin in Papanicolaou cervicovaginal tests: Correlation with histologic follow-up and abnormal clinical presentations

Glandular Cell Abnormalities on SurePath Preparations: A Retrospective Review with Cytology-Histology Correlations

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