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Toro de Méndez M, Azuaje de Inglessis AB. Importancia de la adecuación de la muestra citológica en la pesquisa de cáncer de cuello uterino. REPERTORIO DE MEDICINA Y CIRUGÍA 2022. [DOI: 10.31260/repertmedcir.01217372.1085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objetivo: revisión realizada para destacar la importancia de una muestra citológica óptima para la pesquisa de cáncer de cuello uterino y sus lesiones precursoras, con fines preventivos de diagnóstico y conocimiento de los lineamientos de manejo clínico vigentes, mediante una adecuada muestra. Material y metodología. se realizó una búsqueda electrónica en la base de datos PubMed utilizando los siguientes términos y combinaciones: cervical cytology, screening cervical cáncer, Bethesda system, adecuacy, false negatives, clinical follow-up. Las variables fueron la adecuación de la muestra citológica para pesquisa de cáncer de cuello uterino establecida por el sistema Bethesda y el seguimiento clínico vigente. Resultados: la evaluación de la calidad de la muestra citológica se considera como principal aporte de garantía de calidad del sistema Bethesda para el informe de los hallazgos. Existen lineamientos de manejo clínico relacionados con la adecuada muestra y el seguimiento clínico establecidos hace más de una década y que aún son vigentes. Conclusiones: una muestra citológica óptima permite detectar una mayor proporción de lesiones del cuello uterino significativas, contribuye a la efectividad clínica de la pesquisa de cáncer y establece el mejor cuidado para la paciente. Es necesario concientizar al personal involucrado sobre la importancia de obtener muestras adecuadas.
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Lin M, Narkcham S, Jones A, Armylagos D, DiPietro B, Okafor O, Tracey P, Vercher T, Vasquez S, Haley S, Crumley S, Gorman B, Jacobi E, Amrikachi M, Coffey D, Mody D, Okoye E. False-negative Papanicolaou tests in women with biopsy-proven invasive endocervical adenocarcinoma/adenocarcinoma in situ: a retrospective analysis with assessment of interobserver agreement. J Am Soc Cytopathol 2022; 11:3-12. [PMID: 34583894 DOI: 10.1016/j.jasc.2021.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/23/2021] [Accepted: 08/03/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The objectives of our study were to identify factors contributing to false-negative Papanicolaou (Pap) tests in patients with endocervical adenocarcinoma (EA) or adenocarcinoma in situ (AIS), and to analyze the impact of educational instruction on interobserver agreement in these cases. MATERIALS AND METHODS False-negative Pap tests from patients with EA/AIS were reviewed by a consensus group and by 12 individual reviewers in 2 rounds, with an educational session on glandular neoplasia in Pap tests conducted between the 2 rounds. RESULTS Of 79 Pap tests from patients with EA/AIS, 57 (72.2%) were diagnosed as abnormal and 22 (27.8%) as negative. Of the 22 false-negative cases, 10 remained negative on consensus review, with false-negative diagnoses attributed to sampling variance. The other 12 cases were upgraded to epithelial abnormalities (including 8 to glandular lesions). The false-negative diagnoses were attributed to screening variance in 2 cases and interpretive variance in 10 cases. On individual review, abnormal cells were misinterpreted as reactive glandular cells or endometrial cells in 7 of 8 and 5 of 8 cases upgraded to glandular abnormalities, respectively. With education, the proportion of individual reviewers demonstrating at least moderate agreement with the consensus diagnosis (Cohen's kappa >0.4) increased from 33% (4 of 12) to 75% (9 of 12). CONCLUSIONS Sampling and interpretive variance each accounted for nearly one-half of the false-negative Pap tests, with underclassification as reactive glandular or endometrial cells the main source of the interpretive variances. Educational instruction significantly decreased the interpretive variance and interobserver variability in the diagnosis of glandular abnormalities.
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Affiliation(s)
- Michelle Lin
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Siroratt Narkcham
- Department of Pathology, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | | | - Donna Armylagos
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Brittany DiPietro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | | | | | | | | | - Susan Haley
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Suzanne Crumley
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Blythe Gorman
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Elizabeth Jacobi
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Mojgan Amrikachi
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Donna Coffey
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Dina Mody
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Ekene Okoye
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas.
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Lashmanova N, Braun A, Cheng L, Gattuso P, Yan L. Endocervical adenocarcinoma in situ-from Papanicolaou test to hysterectomy: a series of 74 cases. J Am Soc Cytopathol 2021; 11:13-20. [PMID: 34509373 DOI: 10.1016/j.jasc.2021.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Endocervical adenocarcinoma in situ (AIS) is not always identified on cervical Papanicolaou (Pap) test cytology because the Pap test has relatively low sensitivity for the diagnosis endocervical glandular lesions. We performed a retrospective study to determine the relative sensitivity of different diagnostic approaches, including Pap tests, cervical biopsy and/or endocervical curettage, loop electrosurgical excision procedure (LEEP), and hysterectomy specimens. METHODS Cases of endocervical AIS diagnosed from August 2005 to January 2019 were retrieved from our institution's pathology databases, and their clinicopathologic features were reviewed. RESULTS A total of 74 patients with endocervical AIS with or without concurrent squamous intraepithelial lesions or cervical neoplasms were identified. Their mean age at diagnosis was 39.9 years. More than one half of the cases of AIS were not detected from screening Pap tests but were diagnosed during histologic examination of cervical biopsy or endocervical curettage, LEEP, or cone biopsy specimens (~66%). Only a few patients had had a definitive diagnosis of AIS from the Pap tests (10.8%). Other abnormal glandular cytology included atypical glandular cells, not otherwise specified (16.2%), atypical glandular cells favoring neoplasia (5.4%), and atypical glandular cells suspicious for malignancy (1.3%). Abnormal squamous cytology was common in the study population (54%), with high-grade squamous intraepithelial lesion the most common finding (30%). AIS was diagnosed in 31 of 42 cervical biopsies or curettages, with 16 cases an incidental finding and 15 cases confirming previous abnormal glandular cytology. In addition, AIS was identified in 51 of 53 LEEPs. Approximately 41.5% of those undergoing LEEP had a previous diagnosis of AIS, and 54.7% of the cases were incidental findings. More than one half of the AIS cases harbored significant concurrent cervical lesions, including 26.7% with high-grade squamous intraepithelial lesion, 5.7% with low-grade squamous intraepithelial lesion, 1.9% with invasive squamous cell carcinoma, 20.9% with invasive adenocarcinoma, and 6.7% with microinvasive adenocarcinoma. CONCLUSIONS Our results have demonstrated that the ability to detect AIS with routine screening Pap testing or biopsy/curettage has variable efficacy depending on the screening methods. Given the relatively low combined sensitivity of Pap testing and biopsy/endocervical curettage in the diagnosis of AIS, all LEEPs and cervical cone biopsies performed for squamous cell abnormalities should be thoroughly evaluated for glandular lesions.
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Affiliation(s)
- Natalia Lashmanova
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Ankica Braun
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Lin Cheng
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Lei Yan
- Department of Pathology, Rush University Medical Center, Chicago, Illinois.
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Goyal A, Heymann JJ, Alperstein SA, Siddiqui MT. Underrecognized Patterns of High-Grade Squamous Intraepithelial Lesion on ThinPrep Preparations. Am J Clin Pathol 2021; 156:300-312. [PMID: 33630033 DOI: 10.1093/ajcp/aqaa237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To identify less readily identifiable patterns of high-grade squamous intraepithelial lesions (HSIL) in negative human papillomavirus (HPV)-positive Papanicolaou (Pap) tests on ThinPrep preparations. METHODS Of all HPV-positive Pap tests that were negative for intraepithelial lesion or malignancy (NILM) from July 2013 to June 2018, those with HSIL on subsequent histology within 6 months were identified. ThinPrep slides from the latter group (group 1) and from NILM HPV-negative Pap tests with negative follow-up (group 2) were reviewed independently by 4 participants. Group 1 cases were then reviewed together for consensus and with the ThinPrep Imaging System (TIS). Any discrepancies from the original interpretation were recorded. RESULTS The study cohort included 57 cases each in groups 1 and 2. On final review of group 1 cases, 17 (29.8%) were classified as NILM or unsatisfactory. Of the remaining, 4 cases revealed rare abnormal cells not flagged by the TIS in the fields of view. In the 36 cases (63.1%) with screening or interpretative errors, the key cytologic findings accounting for major discrepancies included atypical metaplastic cells, atypical repair, rare syncytial groups, and atypical immature metaplastic cells. CONCLUSIONS There are 3 main underrecognized patterns of HSIL in cervical cytology: atypical metaplastic cells, atypical repair, and rare syncytial groups.
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Affiliation(s)
- Abha Goyal
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Jonas J Heymann
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Susan A Alperstein
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
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Niu S, Molberg K, Thibodeaux J, Rivera-Colon G, Hinson S, Zheng W, Lucas E. Challenges in the Pap diagnosis of endocervical adenocarcinoma in situ. J Am Soc Cytopathol 2019; 8:141-148. [PMID: 31097290 DOI: 10.1016/j.jasc.2018.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 12/27/2018] [Accepted: 12/28/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Recognition of adenocarcinoma in situ (AIS) in cervical cytology is challenging. MATERIALS AND METHODS We calculated the sensitivity and accuracy of Papanicolaou (Pap) tests obtained within 1 year of a histologic diagnosis of AIS from 2007 to 2016. We also correlated it with the coexistence of squamous lesions, calculated the interobserver agreement, and compared these measures with those of endocervical adenocarcinoma (ECCA). We correlated AIS detection with high-risk human papillomavirus (hrHPV) status. RESULTS Of 72 patients with histologic AIS and 48 patients with ECCA, 92% and 87.5%, respectively, had abnormal Pap test results. A glandular abnormality was detected in 44.4% of the AIS and 77.1% of the ECCA cases. Complete cytohistologic concordance was reached in 8.3% of AIS and 22.9% of ECCA cases. In addition, 27.8% of AIS and 6.3% of ECCA cases were diagnosed on Pap as a high-risk squamous abnormality. Concurrent squamous lesions were present in 79.2% of patients with AIS and 29.2% of patients with ECCA. The Paps from the AIS and ECCA cases were diagnosed as pure squamous abnormalities in 47.2% and 10.4% of cases, respectively. In the AIS cases, interobserver agreement was substantial for detection of any high-risk cytologic abnormality (kappa = 0.67) and fair for detection of any glandular abnormality (kappa = 0.34). Among the 26 patients with AIS tested for hrHPV, 92% had positive results and 8% had negative results. CONCLUSIONS The cytologic sensitivity for the detection of AIS remains low. It is directly related to the coexistence of squamous lesions. Cytology and hrHPV as stand-alone screening tests fail in the early detection of a small proportion of glandular lesions, although combined testing will improve their detection rates.
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Affiliation(s)
- Shuang Niu
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kyle Molberg
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joel Thibodeaux
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Glorimar Rivera-Colon
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Stacy Hinson
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Wenxin Zheng
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elena Lucas
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Liu S, Gibbons-Fideler IS, Tonkovich D, Shen R, Li Z. The reporting rates of atypical glandular cells and their HPV testing and histologic follow-up results: a comparison between ThinPrep and SurePath preparations from a single academic institution. J Am Soc Cytopathol 2019; 8:128-132. [PMID: 31097288 DOI: 10.1016/j.jasc.2018.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 11/19/2018] [Accepted: 11/24/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The interpretation of atypical glandular cells (AGCs) remains a major challenge in gynecologic cytopathology using liquid-based cytology (LBC) (ThinPrep and SurePath). The comparison of performance of detecting glandular abnormalities using these 2 methods is lacking. We investigated the reporting rates of AGCs, human papillomavirus (HPV) testing, and histologic follow-up results in ThinPrep (TP) and SurePath (SP) samples. MATERIALS AND METHODS In our institution, both TP and SP were utilized during the period between January 2014 and June 2017. A retrospective search was conducted to identify patients with AGCs from 58,591 LBCs (27,041 TP and 31,550 SP). Roche (Pleasanton, CA) cobas HPV testing and histologic follow-up results were collected. RESULTS The reporting rates of AGCs for TP (0.7%) or SP (0.2%) were within the College of American Pathologists benchmark ranges, but the reporting for TP was significantly greater than that for SP (P < 0.0001). The HPV-positive rates were 26.0% and 19.4% in TP-AGCs and SP-AGCs, respectively, with no statistical significance. A total of 137 (74.9%) TP-AGCs and 54 (74%) SP-AGCs had histologic follow-up. High-grade squamous intraepithelial lesions (HSIL)/squamous cell carcinoma were identified in 8.8% (12 of 137) of TP-AGCs and 13% (7 of 54) of SP-AGCs. Adenocarcinomas including endocervical and endometrial adenocarcinomas were identified in 9.5% (13 of 137) of TP-AGCs and 13% (7 of 54) of SP-AGCs. Together, 18.2% (25 of 137) of TP-AGCs and 25.9% (14 of 54) of SP-AGCs showed either HSIL or carcinoma in histologic follow-up, but with no statistical significance. CONCLUSIONS TP preparation detected considerably more AGCs than SP preparation. There was no statistical significant difference in HPV-positive rates or histologic follow-up outcomes between TP-detected AGCs and SP-detected AGCs.
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Affiliation(s)
- Shiguang Liu
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Dena Tonkovich
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Rulong Shen
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Zaibo Li
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Rader JS, Tsaih SW, Fullin D, Murray MW, Iden M, Zimmermann MT, Flister MJ. Genetic variations in human papillomavirus and cervical cancer outcomes. Int J Cancer 2019; 144:2206-2214. [PMID: 30515767 DOI: 10.1002/ijc.32038] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/27/2018] [Indexed: 12/12/2022]
Abstract
Cervical cancer is driven by persistent infection of human papillomavirus (HPV), which is influenced by HPV type and intratypic variants, yet the impact of HPV type and intratypic variants on patient outcomes is far less understood. Here, we examined the association of cervical cancer stage and survival with HPV type, clade, lineage, and intratypic variants within the HPV E6 locus. Of 1,028 HPV-positive cases recruited through the CerGE study, 301 were in-situ and 727 were invasive cervical cancer (ICC), with an average post-diagnosis follow-up of 4.8 years. HPV sequencing was performed using tumor-isolated DNA to assign HPV type, HPV 16 lineage, clade, and intratypic variants within the HPV 16 E6 locus, of which nonsynonomous variants were functionally annotated by molecular modeling. HPV 18-related types were more prevalent in ICC compared to in-situ disease and associated with significantly worse recurrence-free survival (RFS) compared to HPV 16-related types. The HPV 16 Asian American lineage D3 and Asian lineage A4 associated more frequently with ICC than with in situ disease and women with an intratypic HPV 16 lineage B exhibited a trend toward worse RFS than those with A, C, or D lineages. Participants with intratypic E6 variants predicted to stabilize the E6-E6AP-p53 complex had worse RFS. Variants within the highly immunogenic HPV 16 E6 region (E14-I34) were enriched in ICC compared to in-situ lesions but were not associated with survival. Collectively, our results suggest that cervical cancer outcome is associated with HPV variants that affect virus-host interactions.
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Affiliation(s)
- Janet S Rader
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shirng-Wern Tsaih
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, USA.,Genomics Sciences and Precision Medicine Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Daniel Fullin
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Miriam W Murray
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Marissa Iden
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael T Zimmermann
- Genomics Sciences and Precision Medicine Center, Medical College of Wisconsin, Milwaukee, WI, USA.,Medical College of Wisconsin, Clinical and Translational Sciences Institute, Milwaukee, WI, USA
| | - Michael J Flister
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, USA.,Genomics Sciences and Precision Medicine Center, Medical College of Wisconsin, Milwaukee, WI, USA
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Goodman S, Mody RR, Coffey D, Gorman BK, Luna E, Armylagos D, Schwartz MR, Mody DR, Ge Y. Negative Pap tests in women with high-grade cervical lesions on follow-up biopsies: Contributing factors and role of human papillomavirus genotyping. Diagn Cytopathol 2017; 46:239-243. [DOI: 10.1002/dc.23874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/30/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Steven Goodman
- Department of Pathology and Genomic Medicine; Houston Methodist Hospital; Houston Texas
| | - Roxanne R. Mody
- Department of Obstetrics and Gynecology; St. Joseph's Hospital; Denver Colorado
| | - Donna Coffey
- Department of Pathology and Genomic Medicine; Houston Methodist Hospital; Houston Texas
| | - Blythe K. Gorman
- Department of Pathology and Genomic Medicine; Houston Methodist Hospital; Houston Texas
| | - Eric Luna
- BioReference Laboratories; Houston Texas
| | | | - Mary R. Schwartz
- Department of Pathology and Genomic Medicine; Houston Methodist Hospital; Houston Texas
| | - Dina R. Mody
- Department of Pathology and Genomic Medicine; Houston Methodist Hospital; Houston Texas
- Weill Medical College of Cornell University; New York New York
| | - Yimin Ge
- Department of Pathology and Genomic Medicine; Houston Methodist Hospital; Houston Texas
- Weill Medical College of Cornell University; New York New York
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