Pap smears with glandular cell abnormalities: Are they detected by rapid prescreening?

BACKGROUND: Rapid prescreening (RPS) is one of the quality assurance (QA) methods used in gynecologic cytology. The efficacy of RPS has been previously studied but mostly with respect to squamous lesions; in fact, there has been no study so far specifically looking at the sensitivity of RPS for detecting glandular cell abnormalities. METHODS: A total of 80,565 Papanicolaou (Pap) smears underwent RPS during a 25-month period. A sample was designated as "review for abnormality" (R) if any abnormal cells (at the threshold of atypical squamous cells of undetermined significance/atypical glandular cells [AGC]) were thought to be present or was designated as negative (N) if none were detected. Each sample then underwent full screening (FS) and was designated as either R or N and also given a cytologic interpretation. RESULTS: The final cytologic interpretation was a glandular cell abnormality (≥AGC) in 107 samples (0.13%); 39 of these (36.4%) were flagged as R on RPS. Twenty-four patients (33.8%) out of 71 who had histologic follow-up were found to harbor a high-grade squamous intraepithelial lesion or carcinoma; 13 of those 24 Pap smears (54.2%) had been flagged as R on RPS. Notably, 11 AGC cases were picked up by RPS only and not by FS and represented false-negative cases; 2 of these showed endometrial adenocarcinoma on histologic follow-up. CONCLUSIONS: Pap smears with glandular cell abnormalities are often flagged as abnormal by RPS, and this results in a sensitivity of 36.4% (at the AGC threshold). Most importantly, some cases of AGC are detected on Pap smears by RPS only, and this demonstrates that RPS is a valuable QA method.

Urine cytology: does the number of atypical urothelial cells matter? A qualitative and quantitative study of 112 cases.

INTRODUCTION: This study presents a detailed and systematic morphological and quantitative analysis of urine cytology specimens in order to determine which qualitative and quantitative features are mostly associated with high-grade urothelial carcinoma (HGUCA). MATERIAL AND METHODS: This study included 112 urine cytology cases with a surgical follow-up within 1 year that were originally reported as "atypical," "suspicious for HGUCA," or "positive for HGUCA." The morphological characteristics as well as the number of abnormal cells were correlated with a diagnosis of HGUCA on follow-up biopsy. RESULTS: Multivariate analysis showed that the presence of hyperchromatic atypical cells with nuclear-cytoplasmic ratio ≥ 0.7 was an independent predictor of HGUCA. Similarly, irregular nuclear membranes, single cells, and pleomorphism correlated with surgical outcome whereas eccentric nuclear location, prominent nucleoli, nuclear-cytoplasmic ratio between 0.5 and 0.7 did not. Cases with ≤10 atypical cells had significantly lower rates of subsequent HGUCA than did those with >10 atypical cells (58% versus 77%). Cases with ≤5 atypical cells (n = 26) showed similar prediction rates (58%) for HGUCA than did those with 6 to 10 atypical cells (n = 12). CONCLUSIONS: The number of atypical urothelial cells is an important criterion that should be taken into account when assigning cases to the "positive" or the "suspicious" categories. A preliminary cutoff of 10 cells appears to be easily applicable and valid from the clinical standpoint.

The value of the "suspicious for urothelial carcinoma" cytology category: a correlative study of 4 years including 337 patients.

BACKGROUND: The terminology used in reporting urine cytology lacks uniformity and the significance of the "atypical" and "suspicious" categories is still not well established. This results in variable clinical follow-up and management of those cases. The authors sought to investigate the prognostic value of a diagnosis of "suspicious for high-grade urothelial carcinoma" (HGUCA). METHODS: All cases with a "suspicious" or "positive" cytological diagnosis spanning 4 years were included and correlated with the subsequent biopsies obtained within 6 months of urine collection. RESULTS: A total of 447 correlative events (57% positive and 43% suspicious) corresponding to 773 cytology specimens and 337 patients were included. The morphology of the "suspicious" cells was similar to what has recently been reported in the literature as "atypical urothelial cells, cannot exclude HGUCA." A "suspicious" diagnosis was more often rendered than a "positive" one in voided specimens (80% vs 65%, respectively). The mean interval between cytology and biopsy was 31 days. On follow-up, 92% of "suspicious" diagnoses (176 of 191 diagnoses) and 90% of "positive" diagnoses (230 of 256 diagnoses) were found to have a biopsy with a diagnosis of carcinoma (low grade or high grade). A diagnosis of HGUCA followed a "suspicious" and a "positive" diagnosis in 79% and 86% of cases, respectively. CONCLUSIONS: A "suspicious" diagnosis as defined in the current study warrants close investigations and repeat biopsy to rule out HGUCA. In addition, the findings of the current study raise the question of the need for quantitative criteria for diagnosing HGUCA on cytology.

Improvement in the routine screening performance of cytotechnologists over time: a study using rapid prescreening.

BACKGROUND: Documenting the performance of gynecologic screening in actual practice settings is difficult to achieve. In the current study, the screening performance of 11 individual cytotechnologists as well as that of the overall laboratory over 2 consecutive time periods was examined using the rapid prescreening (RPS) method. METHODS: RPS was performed by all cytotechnologists in a single laboratory over 2 separate 8-month periods. The sensitivity of screening for individual and groups of cytotechnologists was examined. For purposes of comparison, cytotechnologists were divided into 2 groups: screeners with an overall routine sensitivity >or=95% and screeners with an overall sensitivity <95%. RESULTS: Atypical squamous cells (ASC) were used as a threshold, and routine screening sensitivity was found to vary from 68.3% to 96.8%. The overall sensitivity of the laboratory for RPS and routine screening was 43.6% and 88.4%, respectively. Over time, the overall laboratory sensitivity of routine screening improved from 85.3% to 91.3% (P = .01). During this same time frame, the sensitivity of the screeners with an overall sensitivity <95% improved from 79.3% to 91.2% (P < .001), whereas the sensitivity of screeners with an overall routine sensitivity >or=95% remained the same (96.1% to 96.4%; P = .6). CONCLUSIONS: In addition to improved overall performance of the laboratory by detecting and correcting errors, the results of the current study indicate that using RPS consistently over time might play a role leading to improved performance of cytotechnologists with an overall routine sensitivity <95% but not of cytotechnologists with an overall routine sensitivity >or=95%.

Unusual microbial organisms seen in two cervical smears.

Very infrequently, unusual microbial organisms are encountered in routine cervical Pap tests. We herein report two such cases in two asymptomatic women. Case 1. A Pap smear of a 16-year-old-female showed rare glandular cells with cytologic features consistent with Cytomegalovirus infection. Case 2. A Pap smear of a 36-year-old female exhibited rare fungal organisms characterized by thin septate hyphae branching into secondary branches (metulae) which carried multiple flask-shaped philiades most consistent with Penicillium species that were "most likely representing contamination." We discuss the cytomorphological features and the differential diagnosis and provide a brief review of the literature on these topics.