Diagnosis Of Atypical Glandular Cells Research Articles

Cytologic Parameters in Predicting the Outcome of Atypical Glandular Cells on Papanicolaou Smears: A Single-Institutional Experience.

Atypical glandular cells (AGCs) diagnosis on Pap (Papanicolaou) smears are uncommon and may represent various benign and malignant lesions. This study aims to report the incidence of AGC on Pap smear, to study the relationship of AGC with malignancy, and to determine cytomorphological features that help in predicting malignancy. Retrospective analytical study conducted in the Department of Oncopathology at Tertiary Cancer and Research Institute. In this retrospective study, we included cases diagnosed with AGC between July 2017 to July 2022. All slides were reviewed and subclassified according to the Bethesda 2014 classification system (TBS). The predetermined cytomorphological features observed in the smears were recorded. The follow-up histopathological diagnoses of the cases were retrieved. The significant cytomorphological and clinicopathological findings for malignancy were determined. Pearson χ2 test with SPSS software version 22 to compare cytologic features of cases with benign and malignant follow-up. The significant cytomorphological features observed in neoplastic cases were cells in 3-dimensional clusters, nuclear overlapping, reniform nucleus, irregular nuclear membrane, increased nuclear size, single macronucleoli, engulfed neutrophils, and prominently vacuolated cytoplasm. The diagnosis of AGC on cytology is associated with clinically significant lesions, and cytomorphologic parameters can be used to predict the benign and malignant outcome.

Analysis of atypical glandular cells in ThinPrep Pap smear and follow-up histopathology

Background Diagnosing atypical glandular cells (AGC) is a significant challenge in cytomorphology. Methods A retrospective study was undertaken to assess the prevalence of AGC and the subsequent histological outcomes over 5 years at a single institution. Results A total of 159,649 ThinPrep Pap tests, including 395 cases of AGC, were retrieved, of which 330 AGC cases had follow-up histopathology. Among these 330 cases, 43.9% were classified as AGC not otherwise specified, followed by AGC-endocervical cells at 33.3%. The most frequently observed histological findings at follow-up included CIN1 and benign mucosa with reactive changes, followed by high-grade squamous intraepithelial lesion and cervical squamous cell carcinoma. The overall 5-year insignificant AGC rate was 0.12%, and the overall 5-year significant AGC rate was 0.08%. Notably, 36.7% of AGC cases tested positive for high-risk human papillomavirus. Interestingly, the level of experience did not significantly impact the rates for significant or insignificant AGC diagnosis. However, senior cytopathologists had a higher AGC report rate compared to their junior peers. Conclusion The AGC diagnostic rate at our institution falls within the range given by the College of American Pathologists. A significant number of cases had follow-up histologic results available, and the overall 5-year insignificant AGC rate was 0.12%.

Role of High-Risk HPV Testing in Papanicolaou Tests With Atypical Glandular Cells With and Without Concurrent Squamous Cell Abnormalities.

Data on Papanicolaou (Pap) tests with atypical glandular cells (AGCs) with concurrent squamous cell abnormalities (AGC + Sq) are limited. We evaluated histologic outcomes and the role of high-risk human papillomavirus (HR-HPV) testing in this setting compared with AGCs without concurrent squamous cell abnormalities (AGC-alone). This study used a retrospective cohort of patients with Pap test diagnoses of AGC + Sq and AGC-alone between October 2013 and August 2021. We included 287 Pap tests from 278 patients. The HR-HPV test was positive in 55% of AGC + Sq cases and 14% of AGC-alone cases (P < .0001). Most AGC + Sq cases displayed squamous lesions (41.5%) or were benign (41.5%) on histology, whereas AGC-alone cases were predominantly benign (72%) or extracervical neoplasms (18%). AGC + Sq cases showed higher rates of significant histologic lesions (P = .0001), which were associated with positive HR-HPV status (P = .0012). In AGC-alone cases, HR-HPV status was associated with significant histology only in patients 50 years of age or younger. In both groups, 20% or more of HR-HPV-negative patients harbored significant lesions. AGC + Sq represents a distinct group of patients. HR-HPV testing and patient age provide useful information in the evaluation of AGC, but triage based on HR-HPV testing is not recommended because of the potential for missing significant lesions.

Association of High-Risk HPV Strains other than 16 And 18 and Diagnosis of Atypical Glandular Cells: A 5-Year Study with Follow-Up

Association of High-Risk HPV Strains other than 16 And 18 and Diagnosis of Atypical Glandular Cells: A 5-Year Study with Follow-Up

Factors Affecting the Histopathological Outcomes of Atypical Glandular Cells on Pap Test.

Background:Glandular cell abnormalities may indicate the presence of pre-malignant or malignant lesions.Aim:This study aimed to investigate the relationship between atypical glandular cells (AGC) and patients' demographics, histopathological outcomes, Human Papillomavirus (HPV) test results.Material and Methods:Between January 2015 and December 2019, women with AGC on Pap tests were retrieved from the hospital electronic database. The patients with AGC on cervicovaginal smears who underwent further pathological, laboratory, and imaging diagnostic testing and who were followed up at least 1-year were included in the study, while those who had a history of cervical dysplasia or cancer, lost during follow-up, or had missing data were excluded.Results:Of 85,692 Pap smears, 114 (0.13%) were diagnosed with AGC, of those 88 cases were eligible for final analysis. Gynecological malignancies were detected in 13 (14.8%) patients; including 6 (6.8%) endometrioid endometrial cancers, 3 (3.4%) non-endometrioid endometrial cancers, 2 (2.3%) cervical adenocarcinomas, 1 (1.1%) cervical squamous cell carcinoma, and 1 (1.1%) high-grade tubal serous cancer. Multivariate analysis revealed that presence of concomitant abnormal squamous lesion (P = 0.002), being 50 years and older (P = 0.028), HPV positivity (P < 0.001), and menopause (P = 0.023) were risk factors for significant pathology.Conclusion:The diagnosis of AGC may be related to the preneoplastic/neoplastic processes. A further comprehensive histopathological examination is required in women with AGC, aged 50 years and older, postmenopausal, HPV-positivity and concomitant squamous cell abnormality Clinicians should consider ovarian pathologies when there is no pathological finding on endometrial or cervical histopathological examination.

Role of cervical cytology in the detection of uterine glandular lesions

Background: Diagnosis of atypical glandular cells (AGCs) is challenging to the cytopathologist due to the overlapping features of various neoplastic and nonneoplastic lesions. The aim of this study was to assess the utility of conventional Papanicolaou (Pap) smears in detecting uterine glandular lesions. Materials and Methods: Archived records of all histopathologically diagnosed endometrial adenocarcinoma and endocervical adenocarcinoma during the study period were identified. Corresponding Pap smears, if available, were retrieved. In addition, all cytologically reported AGCs and adenocarcinoma during the same period were retrieved. Pap smears of histopathology discordance cases were reviewed. The prevalence of AGC and sensitivity and specificity of Pap smears in detecting glandular lesions were calculated. Results: The prevalence of AGC was 0.65%. There were 11 false negatives and 10 false positives initially, which were reduced to 6 and 5, respectively, after the review. The sensitivity and specificity of Pap smear in detecting AGC was 72.9% and 99.81% initially, which improved marginally to 81.8% and 99.9%, respectively. Conclusions: The prevalence of AGC in Pap smears is low with a moderate sensitivity and good specificity. As the association of clinically significant lesion is high, all cases with AGC diagnosis must be followed up with colposcopic and histopathologic examination of uterus and cervix.

Assessment of cytological features of glandular lesions of the cervix on conventional smear preparations-a comprehensive study from a tertiary care hospital.

Atypical glandular cells (AGC) as a diagnostic category in cervicovaginal cytology remains as a challenge to cytopathologists. The aim of the present study is to identify the cytological features helpful in categorizing AGC as reactive or neoplastic upon correlation with histology. The study was a retrospective review of cervical smears, with histopathological follow up, reported as glandular lesions for a period of 9 years. The architectural and nuclear features studied were adapted from The Bethesda System (TBS) to stratify the lesions as AGC, AGC-FN (atypical glandular cells favour neoplasia) and adenocarcinoma. The cytological categories were correlated with histology. A total of 89 cases of which 67 (AGC NOS = 34, AGC FN = 19, adenocarcinoma = 14) with histology were reviewed. Neoplastic lesions were encountered in 14 cases (34.6%). Of the cases diagnosed as AGC-NOS, AGC-FN and adenocarcinoma, 26.5%, 68.4% and 100% respectively were neoplastic on histopathology. Squamous lesions accounted for 14.9% of all the glandular lesions. Rosette or acinar formation and loss of polarity frequently observed in neoplastic lesions as compared to reactive changes (p = 0.0004, p = 0.001). Of the nuclear features, nuclear hyperchromasia or coarse clumping of chromatin along with nuclear membrane irregularity and nuclear pleomorphism was frequently associated with neoplastic lesions as compared to reactive conditions (p = 0.007, p = 0.001, p = 0.0002). A diagnosis of AGC at cytology harbors significant number of malignant lesions when confirmed on biopsy. Architectural features complemented with nuclear characteristics helps in differentiating between reactive and neoplastic conditions. Hence stratifying glandular lesions at cytology according to TBS helps in the management.

The Role of HPV Testing in Cytologic Diagnosis of Atypical Glandular Cells

The Role of HPV Testing in Cytologic Diagnosis of Atypical Glandular Cells

More focus on atypical glandular cells in cervical screening: Risk of significant abnormalities and low histological follow-up rate.

Objectives:Atypical glandular cells (AGC) detected by Papanicolaou (Pap) smears are in close relation with adenocarcinoma and precursors detected by histopathology. Yet, sometimes the cytological diagnosis of AGC has been neglected. With increase of adenocarcinoma and precursors, we need more focus on glandular abnormalities.Material and Methods:Clinicopathological data of patients who had AGC on Pap smears between April 2015 and October 2018 and underwent histological follow-up were retrieved from the computerized database of Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Patients with a prior history of cancer were excluded from the study. Statistical analyses were performed using Pearson’s Chi-square test in SPSS software version 23. P < 0.05 (two sided) was considered as statistical significance.Results:Liquid-based cytological examination of the uterine cervix was carried out in 164,080 women. Five hundred and twenty-five women were diagnosed with AGC, 314 with not otherwise specified (AGC-NOS), and 211 with favor neoplastic (AGC-FN). Only 310 cases had histological follow-up, 168 women (168/314, 53.5%) originally with AGC-NOS on Pap smears, and 142 (142/211, 67.3%) with AGC-FN. The median age of histological significant abnormalities was 46.7 years, and 126 women (126/162, 77.8%) were postmenopausal. Sixty-six cases (66/168, 39.3%) of AGC-NOS had significant abnormalities (96/142, 67.6%, AGC-FN). One hundred and sixty-two cases of significant abnormalities included 40 high-grade squamous abnormalities and 122 glandular abnormalities. AGC-FN was more likely to be associated with a clinically significant abnormalities (P < 0.001) compared to AGC-NOS.Conclusions:Patients with AGC on Pap smears are in close relation with significant abnormalities, especially with significant glandular abnormalities on histopathology slices. AGC should be evaluated vigilantly with histological workup, especially if patients are diagnosed with AGC-FN and are aged 41–60 years. We need more focus on AGC.

Reappraisal of cytology-histology correlation in cervical cytology based on the recent American Society of Cytopathology guidelines (2017) at a cancer research centre.

To assess the impact of recently published American Society of Cytopathology (ASC) guidelines (2017) on the conduct of cervical cytology-histology correlation (CHC). A retrospective review was conducted for cervical biopsies with their corresponding conventional cervical smears over a 7.5-year period (January 2011-June 2018). As per the ASC guidelines, a discrepancy assessment grid was prepared. Major cytology-histology discordance was defined as a diagnosis of high-grade squamous intraepithelial lesion (HSIL) or CIN2+ in one of the tests with negative result in the other. Smears and biopsies of all discordant cases were reviewed for reasons of overcall and undercall. Of the 341 cervical biopsies with corresponding Papanicolaou smear, cytology-histology agreement was noted in 249 (73%) cases. Major discordance was observed in 22 cases (6.4%)-16 undercalls and six overcalls on cytology-while minor discrepancies were noted in 70 cases. Atypical metaplasia and repair changes were the main reasons for overcall while small HSIL cells in atrophic smear and scant HSIL cells were important causes of undercall on cytology review. Using the ASC guidelines, we could improvise upon the existing CHC methodology for categorisation of cyto-histological pairs of cases with a cytological diagnosis of atypical glandular cells. The present study demonstrates, for the first time, that the recent ASC guidelines facilitate cervical CHC, especially for categorisation of cases with atypical glandular cells on cytology. Uniform application of these guidelines would standardise the conduct of cervical CHC internationally and provide scope for inter-laboratory comparison of data as well as enhance self-learning and peer learning.

Morphometric analysis of atypical glandular cells correctly classifies normal, reactive, and atypical cells in cervical smears.

The 2014 Bethesda System diagnostic criteria for atypical glandular cells (AGC) aid in the classification of atypical cells in cervical cytology. Anyway, AGC diagnosis remains challenging, due to low frequencies of this finding (approximately 0.5%-1% of Pap test results), abundance of AGC mimics, and significant interobserver variability. We developed an algorithm based on nuclear areas parameter that can help to differentiate AGC from Normal and Reactive glandular cells. Nuclear areas and perimeters were measured on 16 Pap smears with AGC and 18 with Reactive glandular cells of women aged between 30 and 77. Glandular cells from nonpathological Pap smears were used as controls. For each case, the means, medians, standard deviations, and the minimum and maximum values of both nuclear areas and perimeters of the cells of interest were calculated. The nuclear area analysis showed a 100% specificity in discriminating Normal from Altered cells (either Reactive or AGC), whereas the nuclear perimeter analysis showed a lower specificity (87.5%). Both nuclear area and perimeter variability analysis resulted in high specificity values in distinguishing Reactive cells from AGC. Therefore, a stepwise two-step algorithm using nuclear areas to discriminate Normal from Altered cells, and nuclear area variability to distinguish Reactive from AGC, allowed us to reliably classify the cells into these three categories. The morphometric analysis of nuclear area is a valuable and reliable aid in AGC diagnosis and standardization, easily integrable into common automatic algorithms.

Recours au test virologique HPV dans la prise en charge des atypies glandulaires en Alsace entre 2014 et 2016

ObjectivesThe 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. MethodsWe 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. ResultsIn 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]). ConclusionThe 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.

Clinicopathological Characteristics of Atypical Glandular Cells Determined by Cervical Cytology in Japan: Survey of Gynecologic Oncology Data from the Obstetrical Gynecological Society of Kinki District, Japan

Background: The purpose of this study was to clarify the clinicopathological characteristics of, and the clinical approach used to identify, atypical glandular cells (AGCs) in Japan based on cervical cytology screening. Objectives: This study included 1,254 patients with AGCs who underwent cervical cytology. Method: Data from patients with AGCs were used to examine the practical management of AGCs and the histological results. Results: The incidence of AGCs was 0.20% (1,254/614,791). The 1,254 AGC cases included 859 endocervical cells not otherwise specified (NOS), 3 glandular cells NOS, 91 endocervical cells favor neoplasia (FN), and 301 atypical endometrial cells (AEMCs). Among the 1,254 AGC patients, the histological diagnosis was benign in 666 (53.1%), cervical intraepithelial neoplasia (CIN) 1 in 60 (4.8%), CIN2 in 31 (2.5%), CIN3 in 52 (4.1%), squamous cell carcinoma in 19 (1.5%), adenocarcinoma in situ in 39 (3.1%), cervical adenocarcinoma in 106 (8.5%), endometrial carcinoma in 209 (16.7%), ovarian cancer in 26 (2.1%), other malignancy in 4 (0.3%), and other under follow-up in 42 (3.3%). When the 1,254 AGC patients were divided into three medical intervention degrees according to histology, AGC-NOS, AGC-FN, and AEMC required no medical intervention in 78.7, 13.2, and 25.9% (678, 12, and 78) of the patients, cervical cone resection in 13.0, 9.9, and 0.3% (112, 9, and 1) of the patients, and radical laparotomy for invasive cancer in 8.3, 76.9, and 73.8% (72, 70, and 222) of the patients, respectively. Conclusions: Our histological results supported the medical interventions applied for AGC diagnosis and treatment. AGC cases require careful histological evaluation.

Follow-Up of Women with Cervical Cytological Abnormalities: Progression and Regression Events

Section TitleAbnormalities in the cervix, when identified early by Pap smear, can be treated in the early stages or in the precursor stages of the neoplasia, which may increase the chances of regression of the lesion. The aim to verify the rate of cervical abnormalities and to evaluate the risk of progression or regression associated with age and cytological diagnosis. Methods:The study was conducted in a referral hospital in Southern Brazil, based on the results of pathology and cytopathology laboratory tests of uterine cervix. The historical cohort included patients with an abnormal cytology diagnosis in the period from January 2010 to December 2014, followed until July 2016. Results:A total of 42,389 cervical smears were analyzed, 4,427 of which were eligible for analysis of the evolution of cervical abnormalities. In progression and regression events analysis, we observed that patients with a cytological diagnosis of atypical glandular cells presented a higher risk of cervical abnormality progression (Hazard Ratio: 2.0 and 95% confidence intervals 1.36–3.48). We also observed that patients younger than 25 years old were more likely to regress the cervical lesions (Hazard Ratio:1.4 and 95% confidence intervals 1.20–1.74). Conclusions:The associations found between the events (progression and regression), age and cytological diagnosis, highlights the importance of cytological screening in populations at risk of precursor of cervical cancer lesions, especially in women older than 25 years.

Atypical Glandular Cells: Interobserver Variability according to Clinical Management

Objective: The 2014 Bethesda System diagnostic criteria for atypical glandular cells (AGC) aids in classification of atypical cells in cervical cytology. There is limited literature regarding reproducibility and interobserver variability in the application of the 2014 AGC criteria. Our aim is to assess the interobserver variability of AGC with a focus on how diagnostic categories link with guideline-driven management. Study Design: Three observers re-reviewed 51 previously diagnosed AGC Papanicolaou tests. The diagnoses were categorized as follows: (1) according to guideline-specified management, and (2) as glandular vs. squamous lesions. The κ statistic was used to evaluate interobserver agreement. Results: The interobserver variability per guideline management by weighted 2-observer κ ranged from 0.009 to 0.530, with half of the interobserver pairings meeting the threshold for at least fair-moderate agreement. For categorization as glandular, squamous, or both, unweighted κ yielded at best fair interobserver agreement (κ = 0.250) in 1 pairing, with low κ scores in the remainder of reviewer pairs (range 0.015–0.152). Conclusions: There is significant interobserver variability in the diagnosis of AGC. The AGC cases when divided by clinical management had fair-moderate interobserver agreement, suggesting that diagnostic variability likely has a real effect on patient care. This diagnostic uncertainty should be understood by cytologists and clinicians.

Cytologic parameters predicting neoplasia in Papanicolaou smears with atypical glandular cells and histologic follow-up: a single-institution experience

Studies investigating histologic follow-up of The 2001 Bethesda System diagnosis of atypical glandular cells (AGC) have focused on various screening methods, patient populations, and Papanicolaou preparations. Our aim was to report the histologic follow-up of AGC diagnoses from ThinPrep slides and evaluate specific cytologic features predicting benign or malignant follow-up results. A retrospective search identified liquid-based cervical cytology results interpreted as AGC. AGC diagnoses were stratified into four groups: atypical endometrial cells (AGC-EM); atypical endocervical cells (AGC-EC); AGC, favor neoplastic (AGC-FN); and AGC not otherwise specified (AGC-NOS). Evidence of disease was based on histologic follow-up (biopsy or resection specimen) with a diagnosis of cancer, complex endometrial hyperplasia, or high-grade squamous dysplasia. Available slides were blindly reviewed for specific cytologic features. Statistical analysis compared cytologic factors that would predict benign or malignant follow-up. We interpreted 264 samples as AGC from 2005 through 2009. Of the 246 (93.2%) with follow-up histologic material, 60 (24.4%) were AGC-EM; 36 (14.6%) were AGC-EC; 28 (11.4%) were AGC-FN; and 122 (49.6%) were AGC-NOS. Neoplasia was diagnosed in 80 (32.5%). Neoplastic cases showed significantly increased numbers of single cells, cells in 3-dimensional clusters, engulfed neutrophils, nuclear enlargement, increased nuclear-to-cytoplasmic ratio, irregular nuclear borders, reniform nuclei, loss of polarity, and macronucleoli. Cytologic parameters can be used to predict benign from neoplastic glandular lesions. Biopsy follow-up is necessary to correlate cytologic findings when AGC is diagnosed on a Papanicolaou smear.

Papanicolaou Test Performance in Identification of Glandular Lesions of the Endocervix: Interobserver Variability in the Diagnosis of Atypical Glandular Cells (AGC)

Papanicolaou Test Performance in Identification of Glandular Lesions of the Endocervix: Interobserver Variability in the Diagnosis of Atypical Glandular Cells (AGC)

The histological significance of atypical glandular cells on cervical cytology: Experience at Groote Schuur Hospital, Cape Town, South Africa.

Atypical glandular cells (AGC) identified on Pap tests may be markers for potentially significant pathology. Primarily, to correlate AGC findings at Groote Schuur Hospital (GSH, Cape Town, South Africa) with subsequent histological investigations and attempt to identify predictors of pathology relevant to the clinical management of women with a cytological diagnosis of AGC. Secondly, to compare the GSH data with data from similar international studies. Records of AGC Pap tests were retrieved from the laboratory database in the anatomical pathology laboratory at GSH and clinically relevant information was summarised based on the available information. Standard descriptive statistics were used to summarise the study data, and Fisher's exact test was used to compare categorical outcomes, where possible. Of the 237 women with a cytological diagnosis of AGC and who had subsequent histological diagnoses, 120 (50.6%) had significant pathology (cervical intraepithelial neoplasia (CIN) 2 or worse). Significant cervical pathology was most common in women aged &lt;50 years, while significant endometrial pathology predominated in women aged ≥50 years. The results of the GSH study were largely consistent with international findings, but the risk of malignancy was six times higher in the GSH population than in a comparable international group. AGC identified on Pap tests may be markers for potentially significant pathology. Human papillomavirus DNA testing is recommended for younger women diagnosed with AGC to reduce invasive investigations and minimise expenses in a resource-poor setting.

Adenocarcinoma Endocervical em Mulheres Jovens

A incidência de adenocarcinoma do endocolo está a aumentar, principalmente em mulheres com idades entre os 20 e os 30 anos. O aumento desta incidência, segundo estudos recentes, pode dever-se a infeções persistentes pelo HPV associadas a fatores de risco endógenos e exógenos. O tratamento desta neoplasia requer, por vezes, histerectomia total e consequente infertilidade, sendo motivo de trauma psicológico. O presente trabalho pretende alertar para o desenvolvimento de adenocarcinoma em mulheres cada vez mais jovens, e adicionalmente, fazer uma reflexão acerca dos fatores que poderão estar associados ao aparecimento desta patologia e das causas relacionadas com um diagnóstico tardio, de forma a evitar atuações terapêuticas radicais. Para o efeito, é relatado um caso clínico, realizado no seguimento de uma citologia de rastreio de uma mulher de 30 anos, com diagnóstico citológico de células glandulares atípicas sem outras especificações (AGC, SOE), a qual foi encaminhada para a Unidade de Patologia Cervical do hospital de referência. Foi efetuada uma segunda citologia, em meio líquido, cujo diagnóstico foi adenocarcinoma endocervical (SOE), posteriormente confirmado histologicamente.

Expression and utility of IMP3 in the differential diagnosis of atypical glandular cells and adenocarcinoma in liquid-based cervical cytology

Atypical glandular cell (AGC) interpretation in gynecological cytopathology presents many diagnostic challenges. We evaluated the expression of IMP3 in liquid-based cervical cytology and its utility in differentiating premalignant/malignant glandular lesions from benign/reactive processes. Additionally, we tried to determine whether IMP3 may be useful in differentiating among the types of uterine adenocarcinomas. Our cohort included 82 cases; 59 diagnosed with AGC and 23 with adenocarcinoma (Ac). IMP3 immunocytochemical stain was performed on ThinPrep slides and the results correlated with subsequent biopsy findings. IMP3 positivity was assessed by strong (2+ and 3+) granular cytoplasmic staining in at least one group of three epithelial cells. In the AGC group, IMP3 was positive in 14 (73.7%) of 19 cases that on histologic follow-up were confirmed Ac, and 39 (98.6%) of 40 non-glandular lesions/benign cases were negative. In the Ac group, IMP3 was expressed in 16 (69.6%) of 23 cases, of which 16 (72.2%) of 21 were uterine Ac. By combining the two groups, and excluding the 2 extrauterine carcinomas, IMP3 was positive in 30 (75%) of 40 uterine Ac, most of which (86.7%) were in situ/invasive endocervical Ac, and type II endometrial Ac (Papillary Serous and Clear Cell Carcinoma), and only 40% endometrioid Ac. In ThinPrep slides with AGC, IMP3 positivity predicts the presence of a significant endocervical or endometrial lesion on subsequent histology, and may also be a potential diagnostic tool useful in differentiating among the types of adenocarcinomas of the female lower genital tract.