TY - JOUR
T1 - Challenges in the Pap diagnosis of endocervical adenocarcinoma in situ
AU - Niu, Shuang
AU - Molberg, Kyle
AU - Thibodeaux, Joel
AU - Rivera-Colon, Glorimar
AU - Hinson, Stacy
AU - Zheng, Wenxin
AU - Lucas, Elena
N1 - Publisher Copyright:
© 2019 American Society of Cytopathology
PY - 2019/5/1
Y1 - 2019/5/1
N2 - 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.
AB - 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.
KW - Cervical adenocarcinoma
KW - Cytology
KW - Endocervical AIS
KW - Pap test
KW - Papanicolaou test
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U2 - 10.1016/j.jasc.2018.12.004
DO - 10.1016/j.jasc.2018.12.004
M3 - Article
C2 - 31097290
AN - SCOPUS:85060618547
SN - 2213-2945
VL - 8
SP - 141
EP - 148
JO - Journal of the American Society of Cytopathology
JF - Journal of the American Society of Cytopathology
IS - 3
ER -