| Popis: |
Background:Organized Papanicolaou (Pap) screening in manycountries has markedly reduced the incidence of cervical squamouscell carcinoma. However, the effectiveness of Pap screening for theprevention of cervical adenocarcinoma (AC) remains an open ques-tion. The proportion of intraepithelial lesions to invasive carcinomafor squamous lesions is 5 : 1, while for glandular lesions it is 1 : 3.This data emphasizes the need for improvement of screening forglandular lesions, which are more difficult to screen effectivelythan squamous lesions. By analogy to squamous cell cervical cancerprecursors that demonstrate a wide spectrum of histological chan-ges, some authors have proposed parallel classification schemes forendocervical adenocarcinoma precursors that include lesions with alesser degree of abnormality than adenocarcinomain situ(AIS). Weuse the subgroup ‘atypical glandular cells – favor intraepithelial’ forsuch cytologic atypia (dysplasia). The cytological appearance ofthese atypias of the endocervical epithelium falls between thoseseen in normal glands and in AIS.Aim:To analyze the cytology findings of patients with histologi-cally verified glandular intraepithelial lesions and determine theproportion of appropriate cytologic diagnosis for glandular intraepi-thelial lesion (GIL) of endocervical cylindric epithelium.Patients and Methods:The value of cytology in the detection anddifferential diagnosis was evaluated in 52 patients with a definitivehistologic diagnosis of GIL I (n= 11), GIL II (n= 7) and glandularlesions associated with a squamous component, [GIL I + CIN(n= 14), GIL II + CIN (n= 14), GIL + MIC (n= 6)], on the basis oflesion severity and/or type of epithelium affected. Cellular altera-tions, as well as the type of desquamation in GIL: mild GIL I andmoderate GIL I ; are similar to, but less pronounced than, those in AIS. Feathering is the best criterion for predicting glandular neopla-sia, for distinguishing glandular from squamous lesion and also fordistinguishing between glandular abnormality and non- neoplasticdiagnosis.Results:Cytological findings indicated epithelial abnormality in90.4% (47/52) patients. Considering lesion severity, the cytologicaland histological diagnoses were identical in 80.8% (42/52) patients.The accuracy of cytologic diagnosis according to lesion severity andtype of epithelium was 61.1% (11/18) for glandular lesions and35.3% (12/34) for mixed lesions. In predicting the type of epithe-lium involved, the agreement between the cytological and histolog-ical diagnosis was recorded in 22.2% (4/18) of histologically pure(GIL I) and 20.6% (7/34) of mixed lesions (GIL I, II + CIN/MIC).Conclusion:Cytological analysis of glandular lesion abnormalitiesin vaginal- cervical-endocervical (VCE) smears is associated with anumber of diagnostic difficulties. There is an overlap between thecytological criteria for various glandular and squamous lesions of thecervix, thus requiring more rigorous criteria for defining both benignand malignant cervical glandular lesions. Continuous improvementin cervical specimens and cytodiagnostic skills, better understandingand definition of intraepithelial adenocarcinoma and precursors, andtheir inclusion in the classification of cytologic and histologic cervicalfindings are expected to upgrade the detection and diagnosis of intra-epithelial glandular cervical lesions, and to reduce the morbidity andmortality of invasive cervical adenocarcinoma. |
