ThinPrep Pap Test. Accuracy for glandular disease.
ABSTRACT Although the ThinPrep Pap Test is replacing conventional Pap smears in many clinical practices, experience with the identification of glandular lesions is limited. In this study, ThinPrep cytology of glandular lesions was evaluated in a large, inner city teaching hospital with high rates of glandular abnormality.
Six months of ThinPrep diagnoses in 1998, following nearly 100% conversion of the laboratory to the ThinPrep Pap Test, were compared to January-December 1997 conventional smear diagnoses for glandular disease. Biopsy confirmation was evaluated for these cases. Findings on all biopsy-confirmed glandular cases were also compared to findings on cytology.
Similar overall rates of glandular cytology were found. For conventional smears (12 months), 46 cases were diagnosed out of 43,289 smears (0.11%). For ThinPrep cytology (six months), 36 cases were diagnosed out of 25,783 slides (0.14%, P = NS). In the year 1997, 9 biopsy-confirmed conventional smear diagnoses of adenocarcinoma in situ (AIS) or adenocarcinoma were noted versus 10 for six months of 1998 for the ThinPrep method. A statistically significant reduction in the number of miscellaneous nonglandular (squamous) biopsy diagnoses were found with ThinPrep glandular cytology (14 vs. 4 cases, P < .05). For known biopsy-confirmed glandular cases of AIS or adenocarcinoma, a statistically significant reduction in the cytology false negative rate was noted with the ThinPrep method (17 vs. 4 cases, P < .02).
The ThinPrep method provides more accurate diagnoses of glandular disease, with an increase in both sensitivity and specificity for glandular lesions.
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ABSTRACT: To determine the cytologic features that are most helpful in characterizing significant glandular lesions of the cervix observed on the ThinPrep (TP) Pap test (Cytyc Corp., Boxborough, Massachusetts, U.S.A.) and to compare these features with those published for conventional smears. Thirty-nine TP preparations with cytologic evidence of glandular lesions of the cervix and histologic and/or clinical correlation were studied. These lesions included (1) 11 cases of benign/reactive conditions; (2) 10 cases of adenocarcinoma in situ (AIS), of which 1 had both AIS and carcinoma in situ; (3) 1 case of invasive adenocarcinoma; (4) 15 cases of squamous intraepithelial lesions and squamous cell carcinoma, including 4 with glandular involvement, and (5) 2 cases of adenosquamous cell carcinoma. These cases were reviewed by the first author without knowledge of the histologic diagnosis. Twenty-five previously published cytologic criteria were used to evaluate glandular cells on TP slides. Statistical analysis was performed using Fisher's exact test to determine the significance of the features studied. All glandular lesions had cytologic features on TP similar to those previously described on conventional smears. However, TP slides demonstrated enhanced nuclear features but less-preserved architectural patterns. Reactive lesions showed minimal overlapping without hyperchromasia or mitotic figures and with normal nuclear/cytoplasmic ratios. AIS and invasive adenocarcinoma cases had similar features. Increased cellularity and overcrowding were prominent, whereas feathering, rosettes and cell strips were present but subtle. Glandular lesions of the cervix on TP slides shared many of the characteristic features reported for conventional smears. However, nuclear details were more pronounced in TP slides, while architectural patterns, although present, were relatively subtle.Acta cytologica 48(3):372-9. · 1.56 Impact Factor
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ABSTRACT: In dieser Arbeit wurden konventionelle Pap-Abstriche (KA) mit dem ThinPrep®-(TP-)Test unter Verwendung der Münchener Nomenklatur II verglichen. Es wurden Abstriche von 1000 Patientinnen ausgewertet. Die Präparate wurden nach dem „Split-sample“-(SS)-Protokoll erstellt. Das TP-Verfahren verbesserte die Präparatequalität nicht (16,8% TP und 15,7% KA hatten eine mangelhafte Qualität). Das häufige Fehlen endozervikaler Zellen in den TP (11,7%) könnte durch die SS-Methodik verursacht worden sein. Die Qualität der KA war oft durch Erythrozyten, Leukozyten und Verunreinigungen beeinträchtigt. Die signifikant geringere Häufigkeit unklarer zytologischer Befunde (Pap III) mit TP (4,2% vs. 6,3% mit KA) könnte auf eine bessere Unterscheidungsfähigkeit des TP zwischen Normalbefunden und Dysplasien hinweisen.Beide Abstrichverfahren sind verbesserungsbedürftig. Vergleichende Untersuchungen zur Sensitivität und Spezifität von TP und KA sind aber für eine abschließende Bewertung unumgänglich.