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Norman I, Yilmaz E, Hjerpe A, Hortlund M, Elfström KM, Dillner J. Atypical glandular cells and development of cervical cancer: Population-based cohort study. Int J Cancer 2022; 151:2012-2019. [PMID: 36029205 PMCID: PMC9804756 DOI: 10.1002/ijc.34242] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 01/09/2023]
Abstract
The effect of cervical screening on cervical adenocarcinoma has been variable, possibly because the risk associated with the precursor atypical glandular cells (AGC) is not well known. A cohort of all 885 women in the capital region of Sweden with AGC, a concomitant human papillomavirus (HPV) analysis, and a histopathology was followed until 2019. Cumulative incidence proportions of cervical intraepithelial lesion grade 3 or worse (CIN3+) by HPV type was determined by 1-Kaplan-Meier estimates. Hazard ratios (HR) for CIN3+ or for invasive cancer were estimated with Cox regression. After 2 years of follow-up, the cumulative incidence proportions of CIN3+ were 80% (95% confidence interval [CI]: 74-86%), 58% (95% CI: 50-60%) and 10% (95% CI: 5-18%) among HPV16/18 positive, "other HPV" positive and HPV-negative women, respectively. Among the 300 women with HPV16/18 positive AGC, 217 developed CIN3+ of which 35 were invasive cervical cancer. The 2-year cumulative invasive cancer risk for HPV16/18 positive AGC was 17% (95% CI: 12-24%). Primary HPV-screening had a similar yield of CIN3+ as cytology screening, albeit HPV-negative AGC is by design not detected by HPV screening. Among 241 women with HPV-negative AGC, 11 developed CIN3+ mostly after clinically indicated samples. We found no significant risk differences depending on age or sampling indication. The low CIN3+ risk after HPV-negative AGC implies safety of primary HPV screening. The high risk of invasive cervical cancer after HPV16/18 positive AGC implies that management of this finding is a priority in cervical screening.
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Affiliation(s)
- Ingrid Norman
- Department of Laboratory MedicineKarolinska InstitutetStockholmSweden,Department of Clinical Pathology and Cancer Diagnostics, Center for Cervical Cancer Prevention, Medical Diagnostics KarolinskaKarolinska University HospitalStockholmSweden
| | - Emel Yilmaz
- Department of Clinical Pathology and Cancer Diagnostics, Center for Cervical Cancer Prevention, Medical Diagnostics KarolinskaKarolinska University HospitalStockholmSweden
| | - Anders Hjerpe
- Department of Clinical Pathology and Cancer Diagnostics, Center for Cervical Cancer Prevention, Medical Diagnostics KarolinskaKarolinska University HospitalStockholmSweden
| | - Maria Hortlund
- Department of Laboratory MedicineKarolinska InstitutetStockholmSweden,LINK Medical Research ABMalmöSweden
| | - Klara Miriam Elfström
- Department of Laboratory MedicineKarolinska InstitutetStockholmSweden,Department of Clinical Pathology and Cancer Diagnostics, Center for Cervical Cancer Prevention, Medical Diagnostics KarolinskaKarolinska University HospitalStockholmSweden
| | - Joakim Dillner
- Department of Laboratory MedicineKarolinska InstitutetStockholmSweden,Department of Clinical Pathology and Cancer Diagnostics, Center for Cervical Cancer Prevention, Medical Diagnostics KarolinskaKarolinska University HospitalStockholmSweden
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Zuo T, Levi AW, Lin Q, Abi-Raad R, Adeniran AJ, Cai G. High-Risk Human Papillomavirus Testing, Genotyping, and Histopathologic Follow-up in Women With Abnormal Glandular Cells on Papanicolaou Tests. Am J Clin Pathol 2021; 156:569-576. [PMID: 33728437 DOI: 10.1093/ajcp/aqaa265] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study examined the association of high-risk human papillomavirus (hrHPV) status and HPV genotype with histopathologic follow-ups in women with an atypical glandular cell (AGC) interpretation. METHODS Cases with AGC interpretation on a Papanicolaou (Pap) test were retrieved along with hrHPV testing, genotyping, and histologic follow-up results if available. RESULTS A total of 561 AGC cases were identified, with histologic follow-up available for 471 cases (84%). The follow-up diagnoses included benign or reactive changes (60% of cases), low-grade cervical intraepithelial neoplasia (18%), high-grade cervical intraepithelial neoplasia (CIN2-3; 7%), cervical carcinoma (5%), and other malignancies (10%). Tests for hrHPV were positive in 128 of 426 (30%) cases, including HPV16 (30%), HPV18 (14%) and other HPV subtypes (56%). A positive hrHPV result significantly increased the risk of developing CIN2-3 or cervical carcinoma (odds ratio, 24.6; 95% CI, 9.9-58.9) and HPV16 or HPV18 further increased the risk (odds ratio, 49.5; 95% CI, 17.7-123.7). CONCLUSIONS Our data demonstrate that in women with an AGC Pap interpretation, a positive hrHPV result, especially type 16 or 18, is associated with an increased risk of developing cervical CIN2-3 or higher lesions, suggesting potential implications of hrHPV testing for the management of patients with an AGC result on a Pap test.
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Affiliation(s)
- Tao Zuo
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Angelique W Levi
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Qiongqiong Lin
- Department of Pathology, Wenzhou Medical University Second Affiliated Hospital, Wenzhou, Zhejiang, China
| | - Rita Abi-Raad
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | | | - Guoping Cai
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
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3
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Kawano K, Yamaguchi T, Nasu H, Nishio S, Ushijima K. Subcategorization of atypical glandular cells is useful to identify lesion site. Diagn Cytopathol 2020; 48:1224-1229. [PMID: 32668085 DOI: 10.1002/dc.24549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/19/2020] [Accepted: 06/29/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND In the subcategorization of atypical glandular cells (AGCs), origin of cells should be mentioned to estimate lesion sites for diagnosis. However, cases without subcategorization are often encountered due to limited reproducibility. We evaluated whether the subcategorization of AGC based on the Bethesda terminology can estimate lesion sites. METHODS We retrospectively investigated cases whose cervical smears were interpreted as AGC and underwent pathological assessment at our institution between June 2009 and September 2017. AGC was subcategorized based on the Bethesda System. Not-otherwise-specified (NOS) was subcategorized into endocervical cells (NOS-EC), endometrial cells (NOS-EM), or glandular cells (NOS-G). Favor neoplastic (FN) was subcategorized into endocervical cells (FN-EC) or glandular cells (FN-G). FN-G was further subcategorized into endometrial cells (FN-EM) or unknown origin (FN-UO). Clinicopathological data were retrieved from the medical records. RESULTS Of 88 AGC cases, there were 30 NOS-EC (34.1%), 2 NOS-EM (2.3%), 25 FN-EC (28.4%), 22 FN-EM (25.0%), and 9 FN-UO (10.2%). A significantly higher proportion of neoplastic lesions occurred in FN than in NOS (P <.001). The concordance of AGC subclass and lesion site was 88.0%, 70.7%, and 77.3% in FN-EC, FN-G, and FN-EM, respectively. The concordance of FN-EM and lesion site increased to 88.9% in patients aged >50 years. Of nine cases of FN-UO, six experienced nonendometrioid endometrial cancer and extrauterine malignancy. CONCLUSION Subcategorization of NOS and FN would be useful in estimating neoplastic lesions. Further subcategorization into FN-EC, FN-EM, and FN-UO would similarly be beneficial in estimating the lesion site, especially for small endometrial and extrauterine lesions.
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Affiliation(s)
- Kouichiro Kawano
- Department of Obstetrics and Gynecology, Kurume University, School of Medicine, Kurume, Japan
| | - Tomohiko Yamaguchi
- Division of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Hiroki Nasu
- Department of Obstetrics and Gynecology, Kurume University, School of Medicine, Kurume, Japan
| | - Shin Nishio
- Department of Obstetrics and Gynecology, Kurume University, School of Medicine, Kurume, Japan
| | - Kimio Ushijima
- Department of Obstetrics and Gynecology, Kurume University, School of Medicine, Kurume, Japan
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Vicari M, Guidobaldi L, Perrella E, Bianchi A, Ferrari S, Martucci M, Petitti T, Rabitti C, Crescenzi A. Morphometric analysis of atypical glandular cells correctly classifies normal, reactive, and atypical cells in cervical smears. Diagn Cytopathol 2019; 48:10-16. [DOI: 10.1002/dc.24320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/29/2019] [Accepted: 09/06/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Marco Vicari
- Pathology UnitUniversity Hospital Campus Bio‐Medico of Rome Rome Italy
| | - Leo Guidobaldi
- Cytodiagnostic Service, Microbiology and Virology Unit“Sandro Pertini” Hospital Rome Italy
| | - Eleonora Perrella
- Pathology UnitUniversity Hospital Campus Bio‐Medico of Rome Rome Italy
| | - Antonella Bianchi
- Pathology UnitUniversity Hospital Campus Bio‐Medico of Rome Rome Italy
| | - Simona Ferrari
- Pathology UnitUniversity Hospital Campus Bio‐Medico of Rome Rome Italy
| | | | - Tommasangelo Petitti
- Hygiene, Public Health and statistics Research UnitCampus Bio‐Medico University Rome Italy
| | - Carla Rabitti
- Pathology UnitUniversity Hospital Campus Bio‐Medico of Rome Rome Italy
| | - Anna Crescenzi
- Pathology UnitUniversity Hospital Campus Bio‐Medico of Rome Rome Italy
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Harbhajanka A, Dahoud W, Michael CW. Can we predict histological outcome of distinctive cohorts of patients with glandular cell abnormalities on ThinPrep Papanicolaou testing based on human papillomavirus status, age, and associated squamous abnormalities? Diagn Cytopathol 2019; 47:1028-1036. [DOI: 10.1002/dc.24268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/15/2019] [Accepted: 05/30/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Aparna Harbhajanka
- Department of PathologyUniversity Hospitals Cleveland Medical Center Cleveland Ohio
| | - Wissam Dahoud
- Department of PathologyUniversity Hospitals Cleveland Medical Center Cleveland Ohio
| | - Claire W. Michael
- Department of PathologyUniversity Hospitals Cleveland Medical Center Cleveland Ohio
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Goillot V, Paté M, Delaitre A, Akladios C, Baldauf JJ, Lecointre L. [Use of HPV virologic test for atypical glandular cells in Alsace between 2014 and 2016]. ACTA ACUST UNITED AC 2019; 47:802-807. [PMID: 31336187 DOI: 10.1016/j.gofs.2019.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The new recommendations by the National Institute of Cancer (January 2017) recommend the use of a complementary human papillomavirus (HPV) virologic test during the diagnosis of atypical glandular cells in pap smear. The aim of this study was the performance analysis of the HPV virologic test for the detection of significant histological cervical abnormalities (CIN2 or more) in case of atypical glandular cells before the new recommendations were published. METHODS We performed a descriptive and retrospective cohort study in Alsace between January 2014 and December 2016. We have included, from the EVE-association database, the patients with atypical glandular cells in pap smear. RESULTS In total, 1074 patients had a pap smear with atypical glandular cells ; 0.18% of total pap smears. This study included 152 patients who had a HPV test. We observed 6 cases of CIN2 (3.9%) and 12 cases of CIN3 (7.9%). No in situ adenocarcinoma nor invasive carcinoma were detected. The sensitivity of the HPV test was 88.9% (95% CI: [0.65; 0.99]), the specificity was 65.9% (95% CI: [0.55; 0.76]), the positive predictive value was 34% (95% CI: [0.21; 0.49]) and the negative predictive value was 96.8% (95% CI: [0.89; 0.99]). CONCLUSION The detection of HPV in atypical glandular cells seems to be powerful with an excellent negative predictive value but, because of moderate sensitivity and due to the risk of histologic lesion progression, the current recommendations should to be applied with care.
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Affiliation(s)
- V Goillot
- Service de gynécologie, pôle de gynécologie-obstétrique, CHRU de Strasbourg, 5, avenue Molière, 67200 Strasbourg cedex, France
| | - M Paté
- Service de gynécologie, pôle de gynécologie-obstétrique, CHRU de Strasbourg, 5, avenue Molière, 67200 Strasbourg cedex, France.
| | - A Delaitre
- Département de médecine générale, 4, rue Kirschleger, 67058 Strasbourg cedex, France
| | - C Akladios
- Service de gynécologie, pôle de gynécologie-obstétrique, CHRU de Strasbourg, 5, avenue Molière, 67200 Strasbourg cedex, France
| | - J-J Baldauf
- Service de gynécologie, pôle de gynécologie-obstétrique, CHRU de Strasbourg, 5, avenue Molière, 67200 Strasbourg cedex, France
| | - L Lecointre
- Service de gynécologie, pôle de gynécologie-obstétrique, CHRU de Strasbourg, 5, avenue Molière, 67200 Strasbourg cedex, France
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Ruipérez Pacheco E, Ramírez Mena M, García Santos F, Bellón del Amo M, Coronado Martín P. Diagnóstico citológico de «células glandulares atípicas» como predictor de enfermedad ginecológica oncológica. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2019. [DOI: 10.1016/j.gine.2018.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Norman I, Hjerpe A, Dillner J. Risk of high-grade lesions after atypical glandular cells in cervical screening: a population-based cohort study. BMJ Open 2017; 7:e017070. [PMID: 29247086 PMCID: PMC5735403 DOI: 10.1136/bmjopen-2017-017070] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine how human papillomavirus (HPV) positivity of atypical glandular cells (AGCs) affects the predictive values for the presence of high-grade cervical lesions. DESIGN Population-based cohort study. SETTING Stockholm-Gotland region, Sweden. PARTICIPANTS Between 17 February 2014 and 30 June 2016, there were 562 women with AGC detected in a cervical sample. Registry linkages up to 30 June 2016 identified 392 women with an associated HPV test and a histopathological follow-up. MAIN OUTCOME MEASURE Presence of a high-grade cervical lesion in the cervical biopsy taken after the AGC smear, in relation to the HPV status of the AGC-containing index smear. RESULTS The proportion of HPV-positive AGC was 56% (n=222). In this group, there were six cases of invasive cervical adenocarcinoma, 33 cases of cervical adenocarcinoma in situ and 93 cases of high-grade squamous intraepithelial lesion (HSIL), giving a positive predictive value (PPV) for a cervical high-grade lesion of 60% (132/222). Among the 170 women with HPV-negative AGC, there was one invasive cervical squamous cell cancer and four HSIL, giving an PPV for a cervical high-grade lesion of 2.9% (5/170). This group also contained five endometrial cancers and one breast cancer. CONCLUSIONS HPV triaging of AGC will greatly increase the predictive ability for identifying cervical high-grade lesions (OR: 48.4 (95% CI 19.1 to122.6)) and the high sensitivity (96%; 132/137 women) implies safety of primary HPV screening strategies, with regard to this subset of patients. The measurable risk for endometrial cancer among women with HPV-negative AGC (2.9%) suggests that research on screening for endometrial cancer is needed.
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Affiliation(s)
- Ingrid Norman
- Department of Clinical Pathology and Cytology, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Hjerpe
- Department of Clinical Pathology and Cytology, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joakim Dillner
- Department of Clinical Pathology and Cytology, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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Kim MK, Lee YK, Hong SR, Lim KT. Clinicopathological significance of atypical glandular cells on cervicovaginal Pap smears. Diagn Cytopathol 2017; 45:867-872. [DOI: 10.1002/dc.23777] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/25/2017] [Accepted: 06/15/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Mi-Kyung Kim
- Department of Obstetrics and Gynecology; Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine; Seoul Republic of Korea
| | - Yoo Kyung Lee
- Department of Obstetrics and Gynecology; Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine; Seoul Republic of Korea
| | - Sung Ran Hong
- Department of Pathology; Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine; Seoul Republic of Korea
| | - Kyung Taek Lim
- Department of Obstetrics and Gynecology; Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine; Seoul Republic of Korea
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Puerto de Amaya MB. Anomalías epiteliales glandulares y la importancia de los diagnósticos diferenciales. Estudio de caso. REPERTORIO DE MEDICINA Y CIRUGÍA 2017. [DOI: 10.1016/j.reper.2017.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Significance of high-risk HPV detection in women with atypical glandular cells on Pap testing: Analysis of 1857 cases from an academic institution. Cancer Cytopathol 2016; 125:205-211. [DOI: 10.1002/cncy.21791] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/15/2016] [Accepted: 09/06/2016] [Indexed: 11/07/2022]
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12
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High-Grade Cervical Intraepithelial Neoplasia Detected by Colposcopy-Directed or Random Biopsy Relative to Age, Cytology, Human Papillomavirus 16, and Lesion Size. J Low Genit Tract Dis 2016; 20:207-12. [DOI: 10.1097/lgt.0000000000000184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Pradhan D, Li Z, Ocque R, Patadji S, Zhao C. Clinical significance of atypical glandular cells in Pap tests: An analysis of more than 3000 cases at a large academic women's center. Cancer Cytopathol 2016; 124:589-95. [DOI: 10.1002/cncy.21724] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 03/26/2016] [Accepted: 03/29/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Dinesh Pradhan
- Department of Pathology; Magee-Womens Hospital, University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Zaibo Li
- Department of Pathology; Magee-Womens Hospital, University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Rebecca Ocque
- Department of Pathology; Magee-Womens Hospital, University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Stell Patadji
- Department of Pathology; Magee-Womens Hospital, University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Chengquan Zhao
- Department of Pathology; Magee-Womens Hospital, University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
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Dhamne S, Soundars E, Zarrin-Khameh N. Pathologic findings in women with atypical glandular cells on Pap test. J Am Soc Cytopathol 2016; 5:50-55. [PMID: 31042539 DOI: 10.1016/j.jasc.2015.09.213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 09/05/2015] [Accepted: 09/06/2015] [Indexed: 06/09/2023]
Abstract
INTRODUCTION It has been shown that a significant subset of atypical glandular cells (AGC) indicates underlying malignancies. Therefore, it is imperative to recognize, diagnose, and treat these lesions early. We evaluated the clinical significance of AGC on cervical cytology in our hospital. MATERIALS AND METHODS A total of 376 consecutive Pap tests with a diagnosis of AGC between January 2005 and January 2011 at a tertiary community hospital were reviewed and correlated with concurrent or follow-up histopathology. RESULTS Over a 6-year period 376 (0.23%) Pap tests were reported as AGC. Histopathology was available in 223 cases. Atypical hyperplasia, dysplasia, or malignant lesion was found in 128 (57.4%) cases. Of these, 80 (62.5%) were glandular lesions. In women younger than 48 years benign lesions (52.9%) were more common. Women who were 48 years and older were more likely to have a malignant glandular lesion (56 out of 73, 76.7%) compared with women under 48 years, who were more likely to have a malignant squamous lesion (31 out of 55, 56.4%).This difference was statistically significant (P = 0.002). Malignant lesion was seen in 58 (26%) of the women. Endometrial carcinoma (30 cases) was the most common malignancy-51.7% of the malignant lesions and 13.4% overall. Chronic cervicitis and endometritis were the most common non-malignant findings. CONCLUSION AGC on Pap test may be the initial manifestation of a wide range of cervical pathologies. Because many AGC diagnoses did not have a histopathological follow-up, clinicans should be more diligent at having patients follow up, especially in peri- and post-menopausal women.
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Affiliation(s)
- Sagar Dhamne
- Department of Pathology and Immunology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030.
| | - Esther Soundars
- Department of Pathology and Immunology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030.
| | - Neda Zarrin-Khameh
- Department of Pathology and Immunology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030.
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Chang CC, Ou YC, Wang KL, Chang TC, Cheng YM, Chen CH, Chu TY, Hsu ST, Liou WS, Chang YY, Wu HH, Chen TH, Lai HC. Triage of Atypical Glandular Cell by SOX1 and POU4F3 Methylation: A Taiwanese Gynecologic Oncology Group (TGOG) Study. PLoS One 2015; 10:e0128705. [PMID: 26057869 PMCID: PMC4461194 DOI: 10.1371/journal.pone.0128705] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 04/29/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction Invasive procedures including loop electrosurgical excision, cervical conization, and endometrial sampling are often recommended when atypical glandular cells (AGC) are detected on Pap smear with unsatisfactory colposcopy. These invasive procedures may result in patient anxiety, increased medical expense, and increasing the risk of preterm delivery in subsequent pregnancies. This study was performed to assess methylation biomarkers in the triage of AGC on Pap smear for invasive procedures. Methods We conducted a multicenter study in 13 medical centers in Taiwan from May 2012 to May 2014. A total of 55 samples diagnosed “AGC not otherwise specified” (AGC-NOS) were included. All patients with AGC underwent colposcopy, cervical biopsy, endometrial sampling, and conization if indicated. Multiplex quantitative methylation-specific polymerase chain reaction (QMSPCR) was performed. Sensitivity, specificity, and accuracy were calculated for detecting CIN3+ and endometrial complex hyperplasia. Results In 55 patients with AGC, the sensitivity for methylated (m) SOX1m, PAX1 m, ZNF582m,PTPRRm, AJAP1m, HS3ST2m, and POU4F3m for detecting CIN3+ and endometrial complex hyperplasia lesions was 100, 86, 71, 86, 86, 57, and 100%; specificity was 67, 79, 85, 50, 52, 96, and 52%, respectively. Testing for high risk-HPV had a sensitivity of 57% and specificity of 75% for CIN3+ and endometrial complex hyperplasia lesions. Conclusion Methylated (m) SOX1m and POU4F3m could be new methylation biomarkers for detection of CIN3+ and endometrial complex hyperplasia in AGC. Women with AGC and positive SOX1m / POU4F3m, colposcopy, cervical conization or endometrial sampling should be considered.
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Affiliation(s)
- Cheng-Chang Chang
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Yu-Che Ou
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, R.O.C
| | - Kung-Liahng Wang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, R.O.C
| | - Ya-Min Cheng
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, Tainan, Taiwan, R.O.C
| | - Chi-Hau Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C
| | - Tang-Yuan Chu
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, R.O.C
| | - Shih-Tien Hsu
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Wen-Shiung Liou
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C
| | - Yin-Yi Chang
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan, R.O.C
| | - Hua-Hsi Wu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Tze-Ho Chen
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan, R.O.C
| | - Hung-Cheng Lai
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, R.O.C
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, R.O.C
- * E-mail:
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Verdoodt F, Jiang X, Williams M, Schnatz PF, Arbyn M. High-risk HPV testing in the management of atypical glandular cells: A systematic review and meta-analysis. Int J Cancer 2015; 138:303-10. [PMID: 25583258 DOI: 10.1002/ijc.29424] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/07/2015] [Indexed: 12/15/2022]
Abstract
Whereas the utility of high-risk HPV (hrHPV) testing is widely accepted in triage of women with atypical squamous lesions, its role in managing atypical glandular cells (AGC) is not fully elucidated. A systematic review and meta-analysis were performed to evaluate the accuracy of hrHPV testing in the management of women with AGC to detect underlying high-grade intraepithelial neoplasia or worse, and adenocarcinoma in situ or worse (AIS+). Additionally, the diagnosis of extra-cervical cancer was considered as an outcome in this review. A bibliographic database search (PubMed, EMBASE, CENTRAL) identified twelve eligible studies. The occurrence of cervical intraepithelial neoplasia grade two or worse including AIS+ (CIN2+/AIS+), was 19.8% among women with AGC, and 55.7% among women with AGC and concurrent squamous lesions (atypical squamous cells of undetermined significance or worse, ASC-US+). The pooled sensitivity and specificity of hrHPV-testing with Hybrid Capture 2 (HC2) to detect CIN2+/AIS+ in women with AGC was 90.0% (95% CI = 85.1-93.4%) and 75.1% (95% CI = 64.8-83.2%), respectively. Women who were hrHPV-negative, demonstrated an increased risk for extra-cervical malignancy (endometrium, fallopian tube, ovary). In women of 50y and older, a hrHPV-negative result was linked with a 18.0% chance of extra-cervical malignancy, while the chance of cervical pre-cancer and cancer was 0.4 and 0.0%, respectively. In conclusion, given the high risk of underlying CIN2+/AIS+, women with AGC should be referred directly to colposcopy. However, hrHPV test results in combination with the age, appears to improve the diagnostic process by distinguishing the risk for cervical versus non-cervical lesions.
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Affiliation(s)
- Freija Verdoodt
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | - Xuezhi Jiang
- Department of Obstetrics and Gynecology, Reading Hospital, West Reading, PA, USA.,Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark Williams
- Department of Obstetrics and Gynecology, Reading Hospital, West Reading, PA, USA
| | - Peter F Schnatz
- Department of Obstetrics and Gynecology, Reading Hospital, West Reading, PA, USA.,Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA.,Department of Internal Medicine, Reading Hospital, West Reading, PA, USA.,Department of Internal Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
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The Utility of Human Papillomavirus Testing in Young Women With Atypical Glandular Cells on Pap Test. J Low Genit Tract Dis 2015; 19:22-6. [DOI: 10.1097/lgt.0000000000000044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Namugenyi S, Balsan M, Glick S, Jordan J. Prevalence and genotype distribution of human papillomavirus in cytology specimens containing atypical glandular cells: A case–control study. J Clin Virol 2013; 58:432-6. [DOI: 10.1016/j.jcv.2013.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/03/2013] [Accepted: 08/05/2013] [Indexed: 01/30/2023]
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Abstract
Less than 1% of Pap smears are interpreted as having atypical glandular cells. Because of the rarity of diagnosis, providers are frequently unfamiliar with both the workup and the potential ramifications. Comprehensive evaluation is required in all cases to exclude a spectrum of possible diagnoses. Although colposcopy, human papillomavirus DNA testing, endocervical curettage, and endometrial sampling should be the initial part of the evaluation, these procedures may not identify any specific etiology. The aim of this review is to provide the most current strategy for management of this rare, but suspicious Pap test result.
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Affiliation(s)
- John O Schorge
- Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, USA.
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Pan QJ, Hu SY, Zhang X, Ci PW, Zhang WH, Guo HQ, Cao J, Zhao FH, Lytwyn A, Qiao YL. Pooled analysis of the performance of liquid-based cytology in population-based cervical cancer screening studies in China. Cancer Cytopathol 2013; 121:473-82. [PMID: 23907807 DOI: 10.1002/cncy.21297] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Revised: 03/03/2013] [Accepted: 03/05/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Liquid-based cytology (LBC) has been widely used for cervical cancer screening. Despite numerous studies and systematic reviews, to the authors' knowledge few large studies to date have focused on biopsy-confirmed cervical lesions and controversy remains concerning its diagnostic accuracy. The objective of the current study was to assess LBC for detecting biopsy-confirmed cervical intraepithelial neoplasia (CIN) and cancer. METHODS A pooled analysis of LBC using data from 13 population-based, cross-sectional, cervical cancer screening studies performed in China from 1999 to 2008 was performed. Participants (n = 26,782) received LBC and human papillomavirus testing. Women found to be positive on screening were referred for colposcopy and biopsy. The accuracy of LBC for detecting biopsy-confirmed CIN of type 2 or worse (CIN2+) as well as CIN type 3 or worse (CIN3+) lesions was analyzed. RESULTS Of 25,830 women included in the analysis, CIN2+ was found in 107 of 2612 with atypical squamous cells (4.1%), 142 of 923 with low-grade squamous intraepithelial neoplasia (15.4%), 512 of 784 with high-grade squamous intraepithelial neoplasia (65.3%), 29 of 30 with squamous cell carcinoma (96.7%), 4 of 27 with atypical glandular cells (14.8%), and 85 of 21,454 with normal cytology results (0.4%). No invasive cancers were found to have atypical squamous cells, atypical glandular cells, or cytologically normal slides. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of LBC for detecting CIN2+ were 81.0%, 95.4%, 38.3%, 99.3 %, and 94.9%, respectively. Although Hybrid Capture 2 was more sensitive than LBC, the specificity, positive predictive value, and overall accuracy of LBC were higher than those of Hybrid Capture2 at 85.2%, 18.6%, and 85.5%, respectively. CONCLUSIONS The results of the current study indicate that the performance of LBC can effectively predict the risk of existing CIN2+ and may be a good screening tool for cervical cancer prevention in a developing country.
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Affiliation(s)
- Qin-Jing Pan
- Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Mariani R, Grace C, Hughes K, Dietrich RM, Cabay RJ, David O. Can we improve the positive predictive value of atypical glandular cells not otherwise specified? Diagn Cytopathol 2013; 42:200-4. [DOI: 10.1002/dc.22991] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 02/14/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Rachel Mariani
- Department of Pathology; University of Illinois Hospital and Health Sciences System; Chicago Illinois
| | - Chelestes Grace
- Department of Pathology; University of Illinois Hospital and Health Sciences System; Chicago Illinois
| | - Kathryn Hughes
- Department of Pathology; University of Illinois Hospital and Health Sciences System; Chicago Illinois
| | - Ruth M. Dietrich
- Department of Pathology; University of Illinois Hospital and Health Sciences System; Chicago Illinois
| | - Robert J. Cabay
- Department of Pathology; University of Illinois Hospital and Health Sciences System; Chicago Illinois
| | - Odile David
- Department of Pathology; University of Illinois Hospital and Health Sciences System; Chicago Illinois
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Arbyn M, Roelens J, Simoens C, Buntinx F, Paraskevaidis E, Martin-Hirsch PPL, Prendiville WJ. Human papillomavirus testing versus repeat cytology for triage of minor cytological cervical lesions. Cochrane Database Syst Rev 2013; 2013:CD008054. [PMID: 23543559 PMCID: PMC6457841 DOI: 10.1002/14651858.cd008054.pub2] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intra-epithelial lesions (LSIL) are minor lesions of the cervical epithelium, detectable by cytological examination of cells collected from the surface of the cervix of a woman.Usually, women with ASCUS and LSIL do not have cervical (pre-) cancer, however a substantial proportion of them do have underlying high-grade cervical intra-epithelial neoplasia (CIN, grade 2 or 3) and so are at increased risk for developing cervical cancer. Therefore, accurate triage of women with ASCUS or LSIL is required to identify those who need further management.This review evaluates two ways to triage women with ASCUS or LSIL: repeating the cytological test, and DNA testing for high-risk types of the human papillomavirus (hrHPV) - the main causal factor of cervical cancer. OBJECTIVES Main objective To compare the accuracy of hrHPV testing with the Hybrid Capture 2 (HC2) assay against that of repeat cytology for detection of underlying cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) or grade 3 or worse (CIN3+) in women with ASCUS or LSIL. For the HC2 assay, a positive result was defined as proposed by the manufacturer. For repeat cytology, different cut-offs were used to define positivity: Atypical squamous cells of undetermined significance or worse (ASCUS+), low-grade squamous intra-epithelial lesions or worse (LSIL+) or high-grade squamous intra-epithelial lesions or worse (HSIL+).Secondary objective To assess the accuracy of the HC2 assay to detect CIN2+ or CIN3+ in women with ASCUS or LSIL in a larger group of reports of studies that applied hrHPV testing and the reference standard (coloscopy and biopsy), irrespective whether or not repeat cytology was done. SEARCH METHODS We made a comprehensive literature search that included the Cochrane Register of Diagnostic Test Accuracy Studies; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE (through PubMed), and EMBASE (last search 6 January 2011). Selected journals likely to contain relevant papers were handsearched from 1992 to 2010 (December). We also searched CERVIX, the bibliographic database of the Unit of Cancer Epidemiology at the Scientific Institute of Public Health (Brussels, Belgium) which contains more than 20,000 references on cervical cancer.More recent searches, up to December 2012, targeted reports on the accuracy of triage of ASCUS or LSIL with other HPV DNA assays, or HPV RNA assays and other molecular markers. These searches will be used for new Cochrane reviews as well as for updates of the current review. SELECTION CRITERIA Studies eligible for inclusion in the review had to include: women presenting with a cervical cytology result of ASCUS or LSIL, who had undergone both HC2 testing and repeat cytology, or HC2 testing alone, and were subsequently subjected to reference standard verification with colposcopy and colposcopy-directed biopsies for histologic verification. DATA COLLECTION AND ANALYSIS The review authors independently extracted data from the selected studies, and obtained additional data from report authors.Two groups of meta-analyses were performed: group I concerned triage of women with ASCUS, group II concerned women with LSIL. The bivariate model (METADAS-macro in SAS) was used to assess the absolute accuracy of the triage tests in both groups as well as the differences in accuracy between the triage tests. MAIN RESULTS The pooled sensitivity of HC2 was significantly higher than that of repeat cytology at cut-off ASCUS+ to detect CIN2+ in both triage of ASCUS and LSIL (relative sensitivity of 1.27 (95% CI 1.16 to 1.39; P value < 0.0001) and 1.23 (95% CI 1.06 to 1.4; P value 0.007), respectively. In ASCUS triage, the pooled specificity of the triage methods did not differ significantly from each other (relative specificity: 0.99 (95% CI 0.97 to 1.03; P value 0.98)). However, the specificity of HC2 was substantially, and significantly, lower than that of repeat cytology in the triage of LSIL (relative specificity: 0.66 (95% CI 0.58 to 0.75) P value < 0.0001). AUTHORS' CONCLUSIONS HPV-triage with HC2 can be recommended to triage women with ASCUS because it has higher accuracy (significantly higher sensitivity, and similar specificity) than repeat cytology. When triaging women with LSIL, an HC2 test yields a significantly higher sensitivity, but a significantly lower specificity, compared to a repeat cytology. Therefore, practice recommendations for management of women with LSIL should be balanced, taking local circumstances into account.
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Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium.
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Factors predicting pathologic significance among women with atypical glandular cells on liquid-based cytology. Int J Gynaecol Obstet 2012; 119:30-4. [DOI: 10.1016/j.ijgo.2012.05.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 05/11/2012] [Accepted: 06/25/2012] [Indexed: 11/20/2022]
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Hoda RS, Loukeris K, Abdul-Karim FW. Gynecologic cytology on conventional and liquid-based preparations: a comprehensive review of similarities and differences. Diagn Cytopathol 2012; 41:257-78. [PMID: 22508662 DOI: 10.1002/dc.22842] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 01/10/2012] [Indexed: 02/06/2023]
Abstract
Liquid-based preparations (LBPs) have largely replaced conventional Papanicolaou smears (CPS) for cervical samples in the United States and in many other industrialized countries. The two FDA-approved LBP currently in use include ThinPrep (TP), (Hologic Inc., Bedford, MA) and SurePath (SP), (BD Diagnostic, Burlington, NC). Split-sample and direct-to-vial studies have shown that LBPs show an overall improvement in sample collection and processing, reduce artifacts that interfere in diagnosis, are more sensitive, can be utilized for ancillary tests and are a cost-effective replacement for CPS. Comparative analyses of diagnostic accuracy indicate that LBPs perform at least as well as CPS. However, the added advantages of standardized, automated preparations and screening, reduced unsatisfactory rate, improved specimen adequacy and ability to perform human papillomavirus (HPV) test, are enough to continue use of LBP. The cytologic features in LBP are similar to CPS with subtle differences, particularly in background information. There are also subtle differences between the two LBPs, SP and TP, which are reflective of different sampling devices, collection media, and processing techniques. Architecturally, LBP shows smaller cell clusters and sheets and more dyscohesion. Cytologically, enhanced nuclear features and smaller cell size are more prominent. Advances in liquid-based Papanicolaou's (Pap) test have lead to well-defined patient management guidelines by the American Society for Colposcopy and Cervical Pathology. Herein, we review these aspects of Pap test including, morphology, automation, ancillary tests (HPV and immunochemistry), pertinent QA/QC monitors, patient management guidelines, and review of pertinent literature.
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Affiliation(s)
- Rana S Hoda
- Department of Pathology & Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York 10065, USA.
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Value of HPV-DNA test in women with cytological diagnosis of atypical glandular cells (AGC). Eur J Obstet Gynecol Reprod Biol 2011; 159:160-4. [DOI: 10.1016/j.ejogrb.2011.05.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 01/10/2011] [Accepted: 05/19/2011] [Indexed: 01/21/2023]
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Tam KF, Cheung ANY, Szeto E, Ngan HYS. Atypical glandular cells diagnosed during pregnancy and the postpartum period: a retrospective analysis. Eur J Obstet Gynecol Reprod Biol 2011; 155:213-6. [PMID: 21227567 DOI: 10.1016/j.ejogrb.2010.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 11/09/2010] [Accepted: 12/14/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The objective of the study was to determine the prevalence and clinical significance of atypical glandular cells (AGC) or atypical glandular cells of undetermined significance (AGUS) diagnosed in pregnant and postpartum women. STUDY DESIGN Smears having a diagnosis of AGC or AGUS, taken from pregnant and postpartum (within six weeks after delivery) women between 1995 and 2008 were reviewed and subclassified according to the Bethesda 2001 classification. Case records were then reviewed and a second cytology review was performed after disclosure of the follow-up data. RESULTS Among 91,133 smears taken from pregnant and postpartum women, 70 had AGC or AGUS (0.07%) diagnosed. Follow-up data were available in 40 cases, with mean duration of follow-up being 43 months. Among the 40 patients with follow-up data, nineteen had smears with coexisting squamous abnormalities. Thirty patients had positive pathology, including 18 (45%) cervical intraepithelial neoplasia III (CIN III), four (10%) cervical adenocarcinoma-in situ, three (7.5%) squamous cell carcinoma of cervix, four (10%) condylomas and one (2.5%) hydatidiform mole. On review, 24 out of 32 smears with AGC 'not otherwise specified' ('NOS') had significant pathology. CONCLUSIONS AGC found on cervical smears during pregnancy and the postpartum period is uncommon. The chance of having significant cervical pathology, however, is high and colposcopy should be performed.
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Affiliation(s)
- K F Tam
- Department of Obstetrics & Gynaecology, University of Hong Kong, Hong Kong.
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Relationship of atypical glandular cell cytology, age, and human papillomavirus detection to cervical and endometrial cancer risks. Obstet Gynecol 2010; 115:243-248. [PMID: 20093895 DOI: 10.1097/aog.0b013e3181c799a3] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To quantify the age-specific and reproductive organ-specific cancer risk after an atypical glandular cell (AGC) cytologic interpretation in large clinic-based sample in which routine high-risk human papillomavirus (HPV) testing is conducted. METHODS : To estimate the absolute risk of cervical precancer, cervical cancer, and endometrial cancer in women with AGC cytology, we conducted a cross-sectional study of women with AGC cytology (n=1,422) in a large health maintenance organization that introduced high-risk HPV DNA testing into cervical cancer screening in 2003. Risks and binomial exact 95% confidence intervals (CIs) of cervical intraepithelial neoplasia grade 2 or more severe (CIN 2 or worse) and endometrial cancer were calculated. RESULTS A total of 238 women with AGC cytology (16.7%, 95% CI 14.8-18.8%) were diagnosed with CIN 2 or worse, endometrial cancer, or other cancers. Among women aged 50 years or older, 420 high-risk HPV-negative women were at a 10.5% (95% CI 7.7-13.8%) risk of endometrial cancer, and 77 high-risk HPV-positive women were at a 10.4% (95% CI 4.6-19.4%) risk of cervical cancer and 0% (95% CI 0.0-4.7%) risk of endometrial cancer. CONCLUSION High-risk HPV testing may distinguish between risk of endometrial cancer and cervical cancer in women with AGC cervical cytology, particularly in women aged 50 years or older. LEVEL OF EVIDENCE III.
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Zhao C, Florea A, Austin RM. Clinical Utility of Adjunctive High-Risk Human Papillomavirus DNA Testing in Women With Papanicolaou Test Findings of Atypical Glandular Cells. Arch Pathol Lab Med 2010; 134:103-8. [DOI: 10.5858/2008-0755-oar1.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Context.
Atypical glandular cell (AGC) Papanicolaou (Pap) test interpretations are challenging. Most biopsy findings are benign, but AGC results may also reflect highly significant noninvasive neoplastic and malignant histologic outcomes. High-risk human papillomavirus (hrHPV) test use with AGC Pap test results is evolving.
Objective.
To further evaluate the utility and limitations of hrHPV testing with AGC Pap tests.
Design.
Hospital records were searched for AGC Pap tests results from June 1, 2005, to August 31, 2007. Cases of AGC with hrHPV tests and histopathologic follow-up were included.
Results.
Of the 662 women with AGC Pap test results and follow-up analyzed, hrHPV results were available for 309 (46.7%) and were positive in 75 cases (24.3%). Among the 75 cases with hrHPV+ AGC results, 13 (17.3%) had cervical intraepithelial neoplasia grades 2/3, 10 (13.3%) had adenocarcinoma in situ, and 3 (4.0%) had cervical invasive adenocarcinoma, whereas for 234 women with hrHPV− results, 1 (0.4%) had cervical intraepithelial neoplasia grades 2/3, 1 (0.4%) had adenocarcinoma in situ, 1 each (0.4%) had cervical adenocarcinoma and ovarian carcinoma, and 8 (3.4%) had endometrial carcinoma.
Conclusions.
Positive hrHPV AGC results were most strongly associated with cervical intraepithelial neoplasia grades 2/3 and adenocarcinoma in situ in women younger than 50 years. Positive hrHPV AGC results were also present in all 3 cases of invasive cervical adenocarcinoma in women younger than 50 years. Of note, hrHPV− AGC results were present in 10 of 13 carcinomas (76.9%) detected after AGC Pap tests, all in women 40 years or older with endometrial adenocarcinomas (n = 8), ovarian carcinoma (n = 1), and cervical adenosquamous carcinoma in a woman (n = 1) in her 50s. Testing for hrHPV after AGC Pap testing was most helpful in the detection of cervical intraepithelial neoplasia grades 2/3, adenocarcinoma in situ, and invasive cervical adenocarcinomas in women younger than 50 years.
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Sireci AN, Crapanzano JP, Mansukhani M, Wright T, Babiac A, Erroll M, Vazquez M, Saqi A. Atypical glandular cells (AGC): ThinPrep Imaging System (TIS), manual screening (MS), and correlation with Hybrid Capture 2 (HC2) HPV DNA testing. Diagn Cytopathol 2009; 38:705-9. [PMID: 20014311 DOI: 10.1002/dc.21273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The aim of the study was to determine if the ThinPrep Imaging System (T1S) improves the positive predictive value (PPV) of atypical glandular cell (AGC) diagnosis for identifying HPV-related squamous and/or glandular lesions over manual screening (MS), and if human papilloma virus (HPV)-DNA testing improves the diagnostic yield. MATERIALS AND METHODS 85 ThinPrep cervical cytology specimens with a diagnosis of AGC by TIS (n = 51) and MS (n = 34) were retrieved. The diagnoses were correlated with corresponding histologic follow-up and high risk (HR)-HPV testing results. RESULTS The PPV of AGC by TIS and MS for HPV-related squamous lesions were similar. In the MS group, more cases of glandular pathology were identified, however only three represented adenocarcinoma in-situ (AIS), and the remaining ten were endometrial carcinomas (EMCA). CONCLUSIONS TIS and MS are comparable in the detection of AGC representing squamous histology and the addition of HPV DNA testing does not differentially improve performance. Although the MS group harbored more glandular pathology, the differences in the detection of AIS were not statistically significant.
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Affiliation(s)
- Anthony N Sireci
- Department of Pathology and Cell Biology, New York Presbyterian Hospital, Columbia University Medical Center, New York 10032, USA
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Jit M, Gay N, Soldan K, Hong Choi Y, Edmunds WJ. Estimating progression rates for human papillomavirus infection from epidemiological data. Med Decis Making 2009; 30:84-98. [PMID: 19525483 DOI: 10.1177/0272989x09336140] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A Markov model was constructed in order to estimate type-specific rates of cervical lesion progression and regression in women with high-risk human papillomavirus (HPV). The model was fitted to age- and type-specific data regarding the HPV DNA and cytological status of women undergoing cervical screening in a recent screening trial, as well as cervical cancer incidence. It incorporates different assumptions about the way lesions regress, the accuracy of cytological screening, the specificity of HPV DNA testing, and the age-specific prevalence of HPV infection. Combinations of assumptions generate 162 scenarios for squamous cell carcinomas and 54 scenarios for adenocarcinomas. Simulating an unscreened cohort of women infected with high-risk HPV indicates that the probability of an infection continuing to persist and to develop into invasive cancer depends on the length of time it has already persisted. The scenarios and parameter sets that produce the best fit to available epidemiological data provide a basis for modeling the natural history of HPV infection and disease.
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Affiliation(s)
- Mark Jit
- Modelling and Economics Unit, Health Protection Agency Centre for Infections, London, United Kingdom.
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Zhao C, Florea A, Onisko A, Austin RM. 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. Gynecol Oncol 2009; 114:383-9. [PMID: 19501894 DOI: 10.1016/j.ygyno.2009.05.019] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 05/08/2009] [Accepted: 05/09/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Atypical glandular cell (AGC) Pap interpretations and screening for glandular neoplasias remain major challenges. We document the largest reported AGC histopathologic follow-up experience and include verification bias-adjusted data on laboratory screening sensitivity. METHODS AGC Pap tests of endocervical origin (AGC-EC), endometrial origin (AGC-EM), and not otherwise specified (AGC-NOS) were documented at a center serving an older low risk population. 98% of Pap tests were liquid-based cytology (LBC) specimens screened using computer-assisted screening. Follow-up diagnoses were correlated with cytology and stratified into age groups. Screening sensitivity was assessed by examining Pap results during 1 year preceding neoplastic diagnoses. Verification bias was adjusted with findings in over 2000 patients with hysterectomies. RESULTS Of 247,131 Pap tests, 1021 (0.41%) reported AGC results and 662 cases had tissue follow-up. Precancerous or malignant neoplastic histologic outcomes were documented in 101 patients (15.3%), including 8.3% cervical, 6.3% endometrial, and 0.6% ovarian. AGC results were most often associated with neoplastic cervical outcomes in women younger than 40 and with neoplastic endometrial outcomes in women 50 or older. AGC-NOS with a squamous cell abnormality and AGC-EC results suggested cervical neoplasia, while AGC-EM results suggested endometrial neoplasia. CONCLUSIONS AGC Pap results detected significant numbers of cervical and non-cervical neoplasias. Since 38 of 44 (86%) of AGC-detected carcinomas were endometrial or ovarian, HPV co-testing would not have aided screening in detecting the majority of malignancies diagnosed after AGC Pap results. Verification bias-adjusted Pap screening sensitivity in the laboratory for detection of significant neoplastic cervical disease was 93%.
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Affiliation(s)
- Chengquan Zhao
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213-3180, USA.
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Use of Human Papillomavirus Testing in the Management of Atypical Glandular Cells. J Low Genit Tract Dis 2009; 13:94-101. [DOI: 10.1097/lgt.0b013e318183a438] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The Utility of Human Papillomavirus Testing in the Management of Atypical Glandular Cells on Cytology. J Low Genit Tract Dis 2009; 13:72-8. [DOI: 10.1097/lgt.0b013e318183bb0e] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Adhya AK, Mahesha V, Srinivasan R, Nijhawan R, Rajwanshi A, Suri V, Dhaliwal LK. Atypical glandular cells in cervical smears: histological correlation and a suggested plan of management based on age of the patient in a low-resource setting. Cytopathology 2009; 20:375-9. [PMID: 19207306 DOI: 10.1111/j.1365-2303.2008.00629.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To perform an audit of all smears reported as atypical glandular cells (AGC) using the Bethesda system (TBS) 2001. METHODS A total of 18 376 cervical smears were screened from January 2005 to June 2007, of which 65 cases were reported as AGC. Follow-up histology was available in 31 cases (47.7%), in whom a detailed cytological/histological correlation was carried out. RESULTS AGC constituted 0.35% of all Pap smears. Follow-up histology was normal or benign in 20 cases, whereas a squamous or glandular abnormality was seen in 11 cases. Squamous abnormalities included one case each of cervical intraepithelial neoplasia (CIN)1, CIN2 and CIN3 and five cases of squamous cell carcinoma. All glandular epithelial abnormalities were endometrial in origin and included two endometrial adenocarcinomas and one uterine serous carcinoma. Neither in situ nor invasive adenocarcinoma of the endocervix was observed. Review of smears and reclassification as AGC, not otherwise specified and favour neoplasia revealed a higher proportion of abnormality in the latter group, reaffirming the utility of subtyping. The median age of women with AGC was 41 years. The outcome was analysed with respect to the median age. In women aged equal or more than 40 years, AGC reflected a high-grade squamous or glandular epithelial abnormality in 50% of cases compared with none in those less than 40 years old (P = 0.010). CONCLUSION The age of the woman as well as the subtype of atypical glandular cells influences outcome and hence must be taken into consideration while formulating an acceptable management strategy in these women in a low-resource setting.
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Affiliation(s)
- A K Adhya
- Department of Pathology, Postgraduate Institute of Medical Education & Research, Chandigarh, India, Pin - 160012
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Management of Atypical Glandular Cells and Adenocarcinoma in Situ. Obstet Gynecol Clin North Am 2008; 35:623-32; ix. [DOI: 10.1016/j.ogc.2008.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Assessment of reflex human papillomavirus DNA testing in patients with atypical endocervical cells on cervical cytology. Cancer 2008; 114:236-41. [DOI: 10.1002/cncr.23639] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
The addition of the human papillomavirus vaccination and the 2006 national guidelines for the management of abnormal cervical cytology have led to significant changes in the management of cervical disease among adolescents. This article reviews recommendations for prevention, screening, diagnosis, and management of cervical disease.
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2006 consensus guidelines for the management of women with abnormal cervical screening tests. J Low Genit Tract Dis 2007; 11:201-22. [PMID: 17917566 DOI: 10.1097/lgt.0b013e3181585870] [Citation(s) in RCA: 252] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To provide revised evidence-based consensus guidelines for managing women with abnormal cervical cancer screening test results. PARTICIPANTS A group of 146 experts, including representatives from 29 professional organizations, federal agencies, and national and international health organizations, met in Bethesda, MD, September 18-19, 2006, to develop the guidelines. MAJOR CHANGES IN GUIDELINES: The core recommendations for managing women with atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesions were changed minimally. Postcolposcopy management for women with these cytological abnormalities is now identical. Management recommendations for these conditions did change for "special populations," such as adolescents for whom a more conservative approach incorporating cytological follow-up for 2 years was approved. Core recommendations for managing women with high-grade squamous intraepithelial lesions and atypical glandular cells also underwent only minor modifications. More emphasis is placed on immediate "screen-and-treat" approaches when managing women with high-grade squamous intraepithelial lesion. Testing for high-risk human papillomavirus DNA is incorporated into the management of women with atypical glandular cells after their initial evaluation with colposcopy and endometrial sampling. The 2004 Interim Guidance for the use of human papillomavirus DNA testing as an adjunct to cervical cytology for screening in women 30 years and older was formally adopted with only very minor modifications. CONCLUSIONS The 2006 Consensus Guidelines reflect recent data from large clinical trials and advances in technology and are designed to assist clinicians of all subspecialties.
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Wright TC, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D. 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol 2007; 197:346-55. [PMID: 17904957 DOI: 10.1016/j.ajog.2007.07.047] [Citation(s) in RCA: 478] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Revised: 06/28/2007] [Accepted: 07/29/2007] [Indexed: 12/25/2022]
Abstract
A group of 146 experts representing 29 organizations and professional societies met September 18-19, 2006, in Bethesda, MD, to develop revised evidence-based, consensus guidelines for managing women with abnormal cervical cancer screening tests. Recommendations for managing atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion (LSIL) are essentially unchanged. Changes were made for managing these conditions in adolescents for whom cytological follow-up for 2 years was approved. Recommendations for managing high-grade squamous intraepithelial lesion (HSIL) and atypical glandular cells (AGC) also underwent only minor modifications. More emphasis is placed on immediate screen-and-treat approaches for HSIL. Human papillomavirus (HPV) testing is incorporated into the management of AGC after their initial evaluation with colposcopy and endometrial sampling. The 2004 Interim Guidance for HPV testing as an adjunct to cervical cytology for screening in women 30 years of age and older was formally adopted with only very minor modifications.
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Affiliation(s)
- Thomas C Wright
- Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA.
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