Atypical glandular cells

The association of CCAT2 rs6983267 SNP with MYC expression and progression of uterine cervical cancer in the Polish population

PURPOSE

Previous studies have reported a significant contribution of NC_000008.10:g.128413305 G>T (rs6983267) single-nucleotide polymorphism (SNP) in the MYC enhancer region to the susceptibility of various cancers. However, the role of rs6983267 SNP in cervical cancer (CC) development and progression has not been demonstrated to date. Therefore, we evaluated the role of rs6983267 SNP in MYC expression in cervical cancers and non-cancerous cervical tissues. In addition, we assessed the role of this SNP in the development and progression of CC.

METHODS

Using high-resolution melting analysis, we evaluated rs6983267 SNP frequency in women diagnosed with cervical squamous cell carcinoma (SCC) (n = 481) and controls (n = 502) in a Polish Caucasian population. Logistic regression analysis was employed to adjust for the effects of age, parity, oral contraceptive use, tobacco smoking, and menopausal status.

RESULTS

Dividing patients based on clinical characteristics demonstrated an association of the rs6983267 genotype with tumor stage III and grade of differentiation G2 and G3. The p trend value calculated for the rs6983267 SNP in patients with stage III was 0.0006. We also observed a significant contribution of rs6983267 SNP to tumor grade of differentiation G2 and G3. Additional contributors were oral contraceptive use, smoking, and postmenopausal age. We found statistically significant increase of MYC transcript levels in cervical SCC tissues from carriers of the GG vs. T/T (p < 0.00001), G/T vs. T/T (p = 0.0002), and in the non-cancerous cervical tissues from carriers of the GG vs. T/T (p = 0.00046).

CONCLUSION

The rs6983267 SNP may contribute to the increased MYC expression as well as the spread and rapid growth of cervical SCC as compared to lower grade carcinomas.

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

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.

Clinical Utility of Adjunctive High-Risk Human Papillomavirus DNA Testing in Women With Papanicolaou Test Findings of Atypical Glandular Cells

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.

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

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%.

The significance of benign endometrial cells in cervicovaginal smears

The success of the routine Papanicolaou (pap) smear in reducing the incidence and mortality of cervical cancer has been chronicled extensively. Unfortunately, endometrial cancer, the most common malignancy of the gynecologic tract, continues to lack a screening modality of comparable efficacy. It is generally accepted that the Papanicolau test has a low sensitivity for detecting endometrial disease. Nonetheless, it remains true that endometrial cells are not uncommonly identified on routine cervicovaginal smears and along with each case comes an associated responsibility for pathologists to assess cytologic features, assign a potential clinical significance, and make a decision on reporting this finding. When endometrial cells with an entirely normal cytologic appearance are identified on an otherwise unremarkable cervicovaginal smear, the central question raised is whether such cells are exfoliating physiologically or whether their exfoliation is pathologic in response to an underlying endometrial disease. Additionally, in the former scenario, could subsets of patients be defined in which the reporting of this finding is deemed unnecessary in the cytologic report? In this contribution, we explore the clinical significance of finding normal endometrial cells in cervicovaginal smears based on a review of the medical literature of the last half-century. The historical and evidentiary basis for the Bethesda 2001 recommendations, which calls for the reporting of cytologically benign endometrial cells only in patients 40 years and older, is reviewed in detail.

Atypical glandular cells in conventional cervical smears: incidence and follow-up

BACKGROUND

Atypical glandular cells on cervical smears are often associated with clinically significant uterine lesions. The frequency and accuracy of AGC-NOS (i.e. atypical glandular cells, not otherwise specified) diagnoses, regardless of the gland cell type or the degree of suspicion, and their outcome were investigated.

METHODS

From January 1, 1990 to December 31, 1999 a total of 261 patients had an AGC-NOS diagnosis made by conventional cervical Papanicolaou smear interpretation representing 0.05% of all Pap-smears analyzed at the national level. 191 (73.2%) patients had a subsequent histological examination, 8 samples were not representative by origin and were excluded.

RESULTS

Out of 183 AGC-NOS diagnosed, 56.3% (103/183) were associated with tissue-proven precancerous and/or cancerous lesions, 44% being of endocervical and 56% of endometrial origin. 75% of all AGC-patients were asymptomatic. 66.7% (6/9) of the patients with subsequent invasive endocervical adenocarcinoma (AC) and 56% (28/50) of those patients with invasive endometrial AC were without clinical symptoms. 3 patients out of 9 with an invasive endocervical AC were 35 years of age or less. 10.1% and 12.3% of all 'new' tissue-proven invasive endocervical or endometrial AC respectively recorded by the national Morphologic Tumour Registry (MTR) were first identified by a cytological AGC-NOS diagnosis.

CONCLUSION

Our findings emphasize the importance of the cytological AGC-category even in the absence of a precise origin or cell type specification. 56% of the AGC-diagnoses being associated with significant cancerous or precancerous conditions, a complete and careful evaluation is required.