Cellient™ Automated Cell Block System Is Useful in the Differential Diagnosis of Atypical Glandular Cells in Pap Tests
Wei Xing, April Y Hou, Andrew Fischer, Zhong Jiang. University of Massachusetts Medical School, Worcester, MA; Brandeis University, Waltham, MA
Background: Atypical glandular cells (AGC) is an important diagnosis in gynecological cytology. Approximately 10 to 39% of AGC patients will be found to have high grade squamous lesions, glandular dysplasia, or cancer on follow up. The Cellient™ Automated Cell Block System allows efficient and rapid processing of micro-sized cytology samples for histologic sectioning. In this study, we investigate whether Cellient cell blocks could help to distinguish AGC from other cervical lesions on the cytologic Pap test.
Design: Between January 2010 and March 2012 in a large academic medical center, Cellient cell blocks were prepared on 71 cases for which AGC was considered based on the Pap test. Cellient utilizes a flow-through embedding technique and then automatically positions cell samples at a defined plane in paraffin blocks. H&E stained slides from the cell blocks were analyzed.
Results: Fifty five of 71 cases were given a diagnosis of AGC on the Pap smears whereas 16 cases were diagnosed as other than AGC on the Pap smears but were finally signed out by pathologists as AGC. Of the 55 cases, 26 (47%) were signed out by pathologists after reviewing the cell block slides as negative for AGC: diagnoses on the 26 cases were "questionable reactive", n=18; atypical squamous cell of undetermined significance (ASCUS), n=5; low-grade squamous intraepithelial lesion (LSIL), n=3. Eighteen of 55 (33%) cases were signed out as AGC (endocervical origin, n=8; endometrial origin, n=6; NOS, n=4). Importantly, 11 of the 55 (20 %) cases referred to pathologists as AGC were changed to other significant diagnoses including endocervical adenocarcinoma in situ, n=1; invasive carcinomas, n=4; atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H), n=3 and high-grade squamous intraepithelial lesion (HSIL), n=3. Sixteen of 71 cases referred to pathologists with a cytotechnologist diagnosis other than AGC ("questionable reactive", n=9; ASCUS, n=3; ASC-H, n=1; HSIL, n=1; "positive for malignant cells", n=2) were diagnosed as AGC (endocervical origin, n=9; endometrial origin, n=5; NOS, n=1; favor adenocarcinoma, n=1) after cell blocks were examined.
Conclusions: The Cellient™ Automated Cell Block System is a useful technique in the differential diagnosis of AGC. Cell blocks help rule out AGC so that unnecessary colposcopic evaluation or biopsies can be avoided. Cell blocks also help to confirm AGC diagnosis on equivocal smears.
Monday, March 4, 2013 1:00 PM
Poster Session II # 104, Monday Afternoon