[1214] Cytological Results and Clinical Findings Associated with 265 Histopathological Diagnoses of Cervical Glandular Neoplasia: Results of 10 Years

C Zhao, RM Austin. Magee Womens Hospital, UPMC, Pittsburgh

Background: The effects of population screening on cervical glandular neoplasia (CGN) have been limited. The incidence of invasive cervical adenocarcinoma (ICA) has continued to increase during the same period an accelerated decline in cervical squamous carcinoma has been documented, both trends coinciding with the widespread introduction of liquid-based cytology.
Design: A computer-based search of our databases was conducted over a study period of almost 10 years between January 2000 and September 2009 to identify the cases diagnosed surgically as cervical AIS, ICA, or invasive cervical adenosquamous carcinoma. Pathological findings, clinical history, and previous Pap test results were documented.
Results: 265 patients were identified with cervical glandular neoplasia from our databases, including 81 cases of ICA, 17 cases of invasive adenosquamous carcinoma, and 167 cases of AIS. Of these cases, 60% had associated CIN (126 CIN2/3, 34 CIN1).Among 98 women with invasive carcinoma, 85 (86.7%) had associated AIS in histology. The Pap tests or clinical findings leading directly to histologc diagnoses of CGN included 105 (39.6%) AGC/AEC/AIS, 35 (13.2%) HSIL, 16 (6.0%) LSIL, 29 ASC (10.9%), 20 (7.6%) AGC/SIL, 8 (3.0%)AGC/ASC-H, 44 (16.6%) unknown, and 9 (3.4%) with clinical symptom/sign. 23 patients with CIN2/3 cervical biopsy results had AIS diagnosed on subsequent LEEP/Cone biopsies. 14 women with a Pap test history of AGC had initially negative ECC follow-up, not accompanied by cervical biopsies, resulting in delayed diagnoses of CGN. High percentage of women had abnormal and normal Pap test history.

Pap Test History Preceding Abnormal Pap Tests Directly Resulting in Histopathological Diagnoses of Cervical Glandular Neoplasia
Time interval preceding histologic dxNo. PatientsAt least one abnormal Pap test (%)At least one normal Pap test (%)Both normal and abnormal Pap tests (%)AGC Pap test (%)
0-1 yr8026 (32.5)54 (67.5)011 (13.8)
>1-3 yr11441 (36.0)96 (84.2)23 (20.2)18 (15.8)
>3-5 yr12146 (38)109 (90.1)34 (28.1)20 (16.5)



Conclusions: Early diagnosis of cervical glandular neoplasia remains challenging. Preceding negative cytological and histologic results reflect the special challenges associated with both endocervical cytological sampling and with identification and sampling of CGN during colposcopic examinations. Women with AGC Pap should remain classified as high risk patients even after negative/benign histologic follow-up results.
Category: Gynecologic & Obstetrics

Monday, March 22, 2010 11:45 AM

Platform Session: Section D, Monday Morning

 

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