Detection of In Situ and Invasive Endocervical Adenocarcinoma on Thinprep Pap Test: A Study of 71 Histologically-Proven Cases.
Rana S Hoda, Maria Erroll, Suzanne M Brandt, Andrew M Schreiner, Edyta Pirog. New York Presbyterian Hospital, Weill Cornell Medical College, NY
Background: Incidence of in situ and invasive endocervical adenocarcinoma (AIS and ECA) has shown a 25% increase. Data supporting the sensitivity of ThinPrep Pap Test (TPPT) for detection of these lesions is scarce. Herein, we determine sensitivity of TPPT for histologically-proven AIS and ECA with/without associated HSIL and examine discrepancies.
Design: All TPPT (one Pap-stained TP) prior to histologic diagnoses of AIS and ECA over a 6-year-period (2005-to date) were reviewed. TPPT immediately preceding the abnormal histology was defined as the Index Case. Discrepancies in unsatisfactory (Unsat) or negative (Neg) TPPT were evaluated.
Results: 123 TPPT performed in 71 women (age range: 17-70 years; mean: 37) with histologic diagnoses of AIS and ECA were reviewed. Table 1 shows cytology and histopathology correlations for the 71 Index Cases. 65/71 (91.6%) Index TPPT were abnormal. Overall, 41/123 TPPT from 26 women were Unsat (1) or Neg (40). Upon consensus review (RSH, ME) 24 cases (19.5%) from 14 women were true-negative (TN), 2 were Index Cases and 17 cases (13.8%) from 12 women were false-negative (FN), 4 were Index Cases. FN cases preceded histologic AIS and ECA diagnoses by 1 to 34 months. Review diagnoses on FN cases were: AGC/AEC, 13; ASC-H, 2; ASCUS, 2. Reasons for discrepancies included sampling, scant cellularity, lack of traditional morphology of AIS (feathering, palisaded strips, etc.) and ECA (single neoplastic cells, diathesis, etc.) on TP, presence of unusual lesional cytomorphology (small nuclei approximately 7u in diameter with dense chromatin, etc.), and misinterpretation of lesional cells as benign, reactive or metaplastic endocervical or endometrial cells.
|Unsat/Neg||ASCUS/LSIL||HSIL||AGC-EC||AIS||ECA||Total on Cytology|
|Total on Histology||06||09||21||20||05||10||71|