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[278] Should Negative Pap Tests Be Reviewed in Patients with a Newly Diagnosed Endometrial, Cervical or Vaginal Adenocarcinoma?

G Cai, DM Grzybicki, CS Jensen, RJ Zarbo, G Carter, SS Raab. University of Pittsburgh Medical Center, Pittsburgh, PA; University of Iowa Healthcare, Iowa City, IA; Henry Ford Health System, Detroit, MI

Background: Cervicovaginal cytology is primarily a screening test for squamous intraepithelial lesions and squamous cell carcinoma. The detection of glandular lesions in Pap tests has been less successful due to a low sensitivity. The main contributing factors include sampling problem as well as interpretation. Our aim was to determine if retrospective review of negative Pap tests has a value in helping detect glandular epithelial lesions that have been missed in the initial evaluation.
Design: A total of 151 cases with a newly diagnosed endometrial (137 cases), cervical (3 cases), or vaginal (11 cases) adenocarcinoma were retrieved from 1998 to 2004. Their negative Pap tests, performed in the prior 6 months, were reviewed by cytopathologists who were blinded to the original interpretation. The cytopathologists re-interpreted the Pap tests and classified the glandular abnormalities using the Bethesda 2001 terminology, including atypical glandular cells (AGC), atypical glandular cell favor neoplastic (AGC-N), and adenocarcinoma (ACA).
Results: In the retrospective review of the 151 cervicovaginal smears, glandular epithelial abnormalities were found in 37 smears (24.5%). These abnormalities included 27, 5, 5 cases of AGC, AGC-N, and ACA, respectively. In 34 cases with endometrial adenocarcinoma, the Pap tests of 31 cases had newly recognized glandular epithelial abnormalities including 2 cases in which benign endometrial cells were mentioned in the original report. Three cases (2%) were upgraded from AGC to AGC-N or ACA. Regarding the histologic grades of endometrial adenocarcinoma, the glandular epithelial abnormalities were found in 21 of 80 (26%) well differentiated, 7 of 25 (28%) moderately differentiated, and 4 of 17 (24%) poorly differentiated adenocarcinomas.
Conclusions: Retrospective review of negative Pap tests in patients with a newly diagnosed endometrial, cervical and vaginal adenocarcinoma shows a significant number of glandular epithelial abnormalities. These findings indicate that interpretation error plays a role in Pap test false negative diagnoses of glandular cell abnormalities and further study of these lesions could improve detection.
Category: Cytopathology

Tuesday, March 27, 2007

Poster # 66, Tuesday Morning