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: 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 04/2012; 41(3). DOI:10.1002/dc.22842 · 1.52 Impact Factor
Article: Adenocarcinoma cells in Pap smears[Show abstract] [Hide abstract]
ABSTRACT: Adenocarcinomas of the cervix, endometrium, fallopian tube and ovary may present with malignant cells in a Pap smear. In contrast, carcinomas arising outside the female genital tract only rarely present in Pap smears and signs and symptoms of disseminated malignancy are usually evident. Rare isolated metastases to the uterus have been reported and a high index of suspicion is required in such instances. The cell arrangement, pattern of cell spread and the smear background reflect the pathway by which the malignant cells involve the cervix. Recognition of any specific diagnostic features coupled with judicious use of ancillary tests can be of inestimable value. Adequate clinical information, review of past medical history and all previous smears and biopsies form an integral part of the investigation. Consideration of all of these points in conjunction with an appreciation of the classical cytomorphology of endometrioid, serous and clear cell carcinomas should allow a correct diagnosis of extrauterine adenocarcinoma with a high degree of probability.Pathology 01/2009; 41(5):411-8. DOI:10.1080/00313020903042604 · 2.62 Impact Factor
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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 11/2013; 42(7). DOI:10.1002/dc.23077 · 1.52 Impact Factor