Affiliation:
1. Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Rome Italy
2. Pathology Unit, Department of Medicine and Technological Innovation University of Insubria Varese Italy
3. Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, Anatomic Pathology University of Catania Catania Italy
4. Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore Rome Italy
Abstract
AbstractObjectiveThe introduction of cytological screening with the Papanicolau smear significantly reduced cervical cancer mortality. However, Pap smear examination can be challenging, being based on the observer ability to decode different cytological and architectural features. This study aims to evaluate the malignancy rate of AGC (atypical glandular cells) category, investigating the relationships between cytological and histological diagnosis.MethodsEighty‐nine patients, diagnosed as AGC at cytological evaluation and followed up with biopsy or surgical procedure at Policlinico Gemelli Hospital, Rome, Italy, were included in the study. The cytopathological architectural (feathering, rosette formation, overlapping, loss of polarity, papillary formation, three‐dimensional formation) and nuclear (N/C ratio, nuclear enlargement and hyperchromasia, mitoses, nuclei irregularity, evident nucleoli) features of AGC were evaluated. Statistical analyses were performed to assess cyto‐histological correlation and determine the relevance of architectural and nuclear features in the diagnosis of malignancy.ResultsOf the 89 AGC patients, 48 cases (53.93%) were diagnosed as AGC‐NOS and 41 (46.07%) were diagnosed as AGC‐FN, according to the Bethesda classification system. The follow‐up biopsies or surgical resections revealed malignancy in 46 patients (51.69%). The rates of malignancy for AGC‐NOS and AGC‐FN were 35.41% and 70.73% respectively. Furthermore, analysing cytopathological features, we found that both architectural and nuclear criteria were statistically significant (p < 0.05). Only overlapping, nuclear irregularity and increased N/C ratio were not found to be statistically significant for detecting malignancy.ConclusionsCytological diagnosis of glandular lesions remains a valid tool, when appropriate clinical correlation and expert evaluation are available.