Background features of endometrial carcinoma on ThinPrep® cytology
ABSTRACT Conventional smear screening has had little impact on the detection of endometrial carcinoma. Recent studies on liquid-based preparations show promise with increased detection rates of endometrial lesions. The purpose of this 2-yr retrospective study (February 1, 2002-February 29, 2004) was to evaluate the background features on ThinPrep slide preparations from endometrial carcinomas. During this period, 20 (0.06%) cases were diagnosed as adenocarcinoma, of which 15 (75%) showed endometrial carcinoma on cervical or vaginal biopsy. Classic tumor diathesis was present on the slides in 8 (53%) of the cases, the majority of which were from high-grade tumors. In 1 (7%) case, the tumor diathesis consisted of precipitated protein in a watery background. Tumor diathesis was absent in 6 (40%) of the cases, the majority of which were low-grade lesions. Background features on ThinPrep Pap tests from patients with endometrial features range from classic tumor diathesis to clean; findings dependent on the histologic type and grade of the tumor and the extent of the disease process.
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ABSTRACT: Hyperchromatic crowded groups (HCG), a term first introduced into the cytology literature by DeMay in 1995, are commonly observed in Pap tests and may rarely be associated with serious but difficult to interpret lesions. In this study, we specifically defined HCG as dark crowded cell groups with more than 15 cells which can be identified at 10x screening magnification. We evaluated consecutive liquid-based (Surepath) Pap tests from 601 women (age 17-74 years, mean age 29.4 yrs) and observed HCG in 477 cases. In all 477 HCG cases, Pap tests were found to be satisfactory and to contain an endocervical sample. HCG were easily detectable at 10x screening magnification (size up to 400 um, mean 239.5 um) and ranged from 1 to 50 (mean 19.5) per Pap slide. HCG predominantly represented 3-Dimensional groups of endocervical cells with some nuclear overlap (379/477--79%), reactive endocervical cells with relatively prominent nucleoli and some nuclear crowding (29/477--6%), clusters of inflammatory cells (25/477--5.2%), parabasal cells (22/477--4.6%), endometrial cells (1/477--0.2%). Epithelial cell abnormalities (ECA) were present in only 21 of 477 cases (4.6%). 18 of 21 women with HCG-associated ECA were less than 40 years old; only 3 were = or > 40 years. HCG-associated final abnormal Pap test interpretations were as follows: ASCUS (6/21--28%), LSIL (12/21--57%), ASC-H (2/21--9.5%), and HSIL/CIN2-3 (3/21--14%). The association of HCG with ECA was statistically significant (p = 0.0174. chi-square test). In patients with ECA, biopsy results were available in 10 cases, and 4 cases of biopsy-proven CIN2/3 were detected. Among these four cases, HCG in the Pap tests, in retrospect represented the lesional high grade cells in three cases (one HSIL case and two ASC-H cases). Interestingly, none of the 124 cases without HCG were found to have an epithelial cell abnormality. We conclude: a. HCG are observed in a high proportion of cervical smears. b. In the vast majority of cases, HCG are benign. c. ECA were only observed in cases with HCG. This observation is consistent with the hypothesis that the presence of HCG in Pap tests most often represents adequate sampling of the transformation zone, thus increasing the chances of detecting an epithelial cell abnormality. d. Only a few cases with HCG were associated with a serious ECA, but careful scrutiny of all HCG appears warranted to avoid the potential diagnostic pitfall of a significant false negative interpretation.CytoJournal 02/2007; 4:2. DOI:10.1186/1742-6413-4-2
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ABSTRACT: 'The objective of this study is to investigate the potential of classification and regression trees (CARTs) in discriminating benign from malignant endometrial nuclei and lesions. The study was performed on 222 histologically confirmed liquid based cytological smears, specifically: 117 benign cases, 62 malignant cases and 43 hyperplasias with or without atypia. About 100 nuclei were measured from each case using an image analysis system; in total, we collected 22783 nuclei. The nuclei from 50% of the cases (the training set) were used to construct a CART model that was used for knowledge extraction. The nuclei from the remaining 50% of cases (test set) were used to evaluate the stability and performance of the CART on unknown data. Based on the results of the CART for nuclei classification, we propose two classification methods to discriminate benign from malignant cases. The CART model had an overall accuracy for the classification of endometrial nuclei equal to 85%, specificity 90.68%, and sensitivity 72.05%. Both methods for case classification had similar performance: overall accuracy in the range 94-95%, specificity 95%, and sensitivity 91-94%. The results of the proposed system outperform the standard cytological diagnosis of endometrial lesions. This study highlights interesting diagnostic features of endometrial nuclear morphology and provides a new classification approach for endometrial nuclei and cases. The proposed method can be a useful tool for the everyday practice of the cytological laboratory. Diagn. Cytopathol. 2013;. © 2013 Wiley Periodicals, Inc.Diagnostic Cytopathology 07/2014; 42(7). DOI:10.1002/dc.23077 · 1.52 Impact Factor
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ABSTRACT: Liquid-based preparations (LBPs) have largely replaced conventional Papanicolaou smears (CPS) for cervical samples in the United States and in many other industrialized countries. The two FDA-approved LBP currently in use include ThinPrep (TP), (Hologic Inc., Bedford, MA) and SurePath (SP), (BD Diagnostic, Burlington, NC). Split-sample and direct-to-vial studies have shown that LBPs show an overall improvement in sample collection and processing, reduce artifacts that interfere in diagnosis, are more sensitive, can be utilized for ancillary tests and are a cost-effective replacement for CPS. Comparative analyses of diagnostic accuracy indicate that LBPs perform at least as well as CPS. However, the added advantages of standardized, automated preparations and screening, reduced unsatisfactory rate, improved specimen adequacy and ability to perform human papillomavirus (HPV) test, are enough to continue use of LBP. The cytologic features in LBP are similar to CPS with subtle differences, particularly in background information. There are also subtle differences between the two LBPs, SP and TP, which are reflective of different sampling devices, collection media, and processing techniques. Architecturally, LBP shows smaller cell clusters and sheets and more dyscohesion. Cytologically, enhanced nuclear features and smaller cell size are more prominent. Advances in liquid-based Papanicolaou's (Pap) test have lead to well-defined patient management guidelines by the American Society for Colposcopy and Cervical Pathology. Herein, we review these aspects of Pap test including, morphology, automation, ancillary tests (HPV and immunochemistry), pertinent QA/QC monitors, patient management guidelines, and review of pertinent literature. Diagn. Cytopathol. 2012. © 2012 Wiley Periodicals, Inc.Diagnostic Cytopathology 03/2013; 41(3). DOI:10.1002/dc.22842 · 1.52 Impact Factor