Assessment of cytological features of glandular lesions of the cervix on conventional smear preparations-a comprehensive study from a tertiary care hospital.
Adenocarcinoma
/ diagnosis
Carcinoma, Squamous Cell
/ diagnosis
Cervix Uteri
/ pathology
Cytological Techniques
/ methods
Female
Humans
Papanicolaou Test
/ methods
Precancerous Conditions
/ diagnosis
Retrospective Studies
Tertiary Care Centers
Uterine Cervical Neoplasms
/ diagnosis
Vaginal Smears
/ methods
Uterine Cervical Dysplasia
/ diagnosis
AGC
adenocarcinoma
cervical cytology
glandular lesions
Journal
Diagnostic cytopathology
ISSN: 1097-0339
Titre abrégé: Diagn Cytopathol
Pays: United States
ID NLM: 8506895
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
09
04
2020
revised:
04
09
2020
accepted:
09
11
2020
pubmed:
20
11
2020
medline:
15
10
2021
entrez:
19
11
2020
Statut:
ppublish
Résumé
Atypical glandular cells (AGC) as a diagnostic category in cervicovaginal cytology remains as a challenge to cytopathologists. The aim of the present study is to identify the cytological features helpful in categorizing AGC as reactive or neoplastic upon correlation with histology. The study was a retrospective review of cervical smears, with histopathological follow up, reported as glandular lesions for a period of 9 years. The architectural and nuclear features studied were adapted from The Bethesda System (TBS) to stratify the lesions as AGC, AGC-FN (atypical glandular cells favour neoplasia) and adenocarcinoma. The cytological categories were correlated with histology. A total of 89 cases of which 67 (AGC NOS = 34, AGC FN = 19, adenocarcinoma = 14) with histology were reviewed. Neoplastic lesions were encountered in 14 cases (34.6%). Of the cases diagnosed as AGC-NOS, AGC-FN and adenocarcinoma, 26.5%, 68.4% and 100% respectively were neoplastic on histopathology. Squamous lesions accounted for 14.9% of all the glandular lesions. Rosette or acinar formation and loss of polarity frequently observed in neoplastic lesions as compared to reactive changes (p = 0.0004, p = 0.001). Of the nuclear features, nuclear hyperchromasia or coarse clumping of chromatin along with nuclear membrane irregularity and nuclear pleomorphism was frequently associated with neoplastic lesions as compared to reactive conditions (p = 0.007, p = 0.001, p = 0.0002). A diagnosis of AGC at cytology harbors significant number of malignant lesions when confirmed on biopsy. Architectural features complemented with nuclear characteristics helps in differentiating between reactive and neoplastic conditions. Hence stratifying glandular lesions at cytology according to TBS helps in the management.
Sections du résumé
BACKGROUND
BACKGROUND
Atypical glandular cells (AGC) as a diagnostic category in cervicovaginal cytology remains as a challenge to cytopathologists.
AIMS
OBJECTIVE
The aim of the present study is to identify the cytological features helpful in categorizing AGC as reactive or neoplastic upon correlation with histology.
MATERIALS AND METHODS
METHODS
The study was a retrospective review of cervical smears, with histopathological follow up, reported as glandular lesions for a period of 9 years. The architectural and nuclear features studied were adapted from The Bethesda System (TBS) to stratify the lesions as AGC, AGC-FN (atypical glandular cells favour neoplasia) and adenocarcinoma. The cytological categories were correlated with histology.
RESULTS
RESULTS
A total of 89 cases of which 67 (AGC NOS = 34, AGC FN = 19, adenocarcinoma = 14) with histology were reviewed. Neoplastic lesions were encountered in 14 cases (34.6%). Of the cases diagnosed as AGC-NOS, AGC-FN and adenocarcinoma, 26.5%, 68.4% and 100% respectively were neoplastic on histopathology. Squamous lesions accounted for 14.9% of all the glandular lesions. Rosette or acinar formation and loss of polarity frequently observed in neoplastic lesions as compared to reactive changes (p = 0.0004, p = 0.001). Of the nuclear features, nuclear hyperchromasia or coarse clumping of chromatin along with nuclear membrane irregularity and nuclear pleomorphism was frequently associated with neoplastic lesions as compared to reactive conditions (p = 0.007, p = 0.001, p = 0.0002).
CONCLUSION
CONCLUSIONS
A diagnosis of AGC at cytology harbors significant number of malignant lesions when confirmed on biopsy. Architectural features complemented with nuclear characteristics helps in differentiating between reactive and neoplastic conditions. Hence stratifying glandular lesions at cytology according to TBS helps in the management.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
388-394Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Kaarthigeyan K. Cervical cancer in India and HPV vaccination. Indian J Med Paediatr Oncol: Off J Indian Soc Med Paediatr Oncol. 2012;33(1):7.
Shoji T, Takatori E, Takeuchi S, et al. Clinical significance of atypical glandular cells in the Bethesda system 2001: a comparison with the histopathological diagnosis of surgically resected specimens. Cancer Invest. 2014;32(4):105-109.
Solomon D, Davey D, Kurman R, Moriarty A, O'Connor D, Prey M, Raab S, Sherman M, Wilbur D, Wright T Jr, Young N; Forum group members; Bethesda 2001 workshop. The 2001 Bethesda system: terminology for reporting results of cervical cytology. JAMA 2002;287(16):2114-2119. doi:https://doi.org/10.1001/jama.287.16.2114
Cangiarella JF, Chhieng DC. Atypical glandular cells-an update. Diagn Cytopathol. 2003;29(5):271-279.
Behtash N, Nazari Z, Fakhrejahani F, Khafaf A, Azar EG. Clinical and histological significance of atypical glandular cell on pap smear. Australian and New Zealand J Obstetrics Gynaecol. 2007;47(1):46-49.
Wright TC Jr, Cox JT, Massad LS, Twiggs LB, Wilkinson EJ. For the 2001 ASCCP-sponsored consensus conference. 2001 consensus guidelines for the management of women with cervical cytological abnormalities. JAMA. 2002;287(16):2120-2129. https://doi.org/10.1001/jama.287.16.2120.
Duska LR. Can we improve the detection of glandular cervical lesions: the role and limitations of the pap smear diagnosis atypical glandular cells (AGC). Gynecol Oncol. 2009;114(3):381-382.
Lee KR, Manna EA, Jones MA. Comparative cytologic features of adenocarcinoma in situ of the uterine cervix. Acta Cytol. 1990;35(1):117-126.
Belsley A, Tambouret HR, Misdraji J, Muzikansky A, Russell KD, Wilbur DC. Cytologic features of endocervical glandular lesions: comparison of surepath, thinprep, and conventional smear specimen preparations diagn. Cytopathology. 2008;36:232-237.
Siziopikou KP, Wang HH, Abu-Jawdeh G. Cytologic features of neoplastic lesions in endocervical glands. Diagn Cytopathol. 1997;17(1):1-7.
Belsley NA, Tambouret RH, Misdraji J, Muzikansky A, Russell DK, Wilbur DC. Cytologic features of endocervical glandular lesions: comparison of surepath, thinprep, and conventional smear specimen preparations. Diagn Cytopathol. 2008;36(4):232-237.
Ajit D, Gavas S, Joseph S, Rekhi B, Deodhar K, Kane S. Identification of atypical glandular cells in pap smears: is it a hit and miss scenario? Acta Cytol. 2013;57(1):45-53.
Moreira MA, Longatto Filho A, Castelo A, et al. How accurate is cytological diagnosis of cervical glandular lesions? Diagn Cytopathol. 2008;36(4):270-274.
Bose S, Kannan V, Kline TS. Abnormal endocervical cells. Really abnormal? Really endocervical? Am J Clin Pathol. 1994;101:708-713.
Neeta K, Gupta R, Gupta S. Glandular cell abnormalities in cervical cytology: what has changed in this decade and what has not? European J Obstetr Gynecol Reproduct Biol. 2019;240:68-72.
Marques JP, Costa LB, Pinto AP, et al. Atypical glandular cells and cervical cancer: systematic review. Rev Assoc Med Bras. 2011;57:234-238.
Kumar N, Molliet MJ, Bongiovani M, Pelte MF, Egger JF, Pache J. C diverse glandular pathologies coexist with high- grade squamous intraepithelial lesion in cyto-histological review of atypical glandular cells on thinprep. Cytopathology. 2008;20(6):351-358.
Pacey F, Ayer B, Greenberg M. The cytologic diagnosis of adenocarcinoma in situ of the cervix uteri and related lesions. III. Pitfalls in diagnosis. Acta Cytol. 1988;32:325-330.
Lee KR. Atypical glandular cells in cervical smears from women who have undergone cone biopsy a potential diagnostic pitfall. Acta Cytol. 1993;37:705-709.
Novotny DB, Maygarden SJ, Johnson JG, Frable WJ. Tubal metaplasia. A frequent potential pitfall in the cytologic diagnosis of endocervical glandular dysplasia on cervical smears. Acta Cytol. 1992;36:1-10.
Ducatman BS, Wang HH, Jonasson JG, Hogan CL, Antonioli DA. Tubal metaplasia: a cytologic study with comparison to other neoplastic and non-neoplastic conditions of the endocervix. Diagn Cytopathol. 1993;9:98-105.
Wilbur DC. Endocervical glandular atypia: a “new” problem for the cytologist. Diagn Cytopathol. 1995;13:463-469.
de Peralta-Venturino MN, Purslow MJ, Kini SR. Endometrial cells of the “lower uterine segment” (LUS) in cervical smears obtained by endocervical brushings: a source of potential diagnostic pitfall. Diagn Cytopathol. 1995;12:263-271.
Zhao C, Austin RM, Pan J, et al. Clinical significance of atypical glandular cells in conventional pap smears in a large, high-risk U.S. west coast minority population. Gynecol Cytopathol. 2009;53:154-159.
Ronnett BM, Manos MM, Janice ER, et al. Atypical glandular cells of undetermined significance (AGUS): cytopathologic features, histopathologic results, and human papillomavirus DNA detection. Hum Pathol. 1999;30:816-825.