INTERPRETATION / RESULTINTERPRETATION / RESULT EPITHELIAL CELL ABNORMALITIESEPITHELIAL CELL ABNORMALITIES GLANDULAR CELGLANDULAR CEL• AtypicalAtypical

- Endocervical cells ( NOS or specify in comments)- Endocervical cells ( NOS or specify in comments)- Endometrial cells (NOS or specify in comments)- Endometrial cells (NOS or specify in comments)- Glandular cells (NOS or specify in comments)- Glandular cells (NOS or specify in comments)

• AtypicalAtypical- Endocervical cells, favor neoplastic- Endocervical cells, favor neoplastic- Glandular cells, favor neoplastic- Glandular cells, favor neoplastic

• Endocervical adenocarcinoma in situEndocervical adenocarcinoma in situ• AdenocarcinomaAdenocarcinoma

- Endocervical - Endocervical - Endometrial- Endometrial- Extrauterine- Extrauterine- Not otherwise specified (NOS)- Not otherwise specified (NOS)

INTERPRETATION / RESULTINTERPRETATION / RESULT

EPITHELIAL CELL ABNORMALITIESEPITHELIAL CELL ABNORMALITIES GLANDULAR CELLGLANDULAR CELL

- endocervical, endometrial or undetermined origin- endocervical, endometrial or undetermined origin

- “of undetermined significance” (AGUS) qualifier – - “of undetermined significance” (AGUS) qualifier – eliminatedeliminated

- “favor reactive” qualifier – eliminated- “favor reactive” qualifier – eliminated

- “favor neoplastic” qualifier – retained- “favor neoplastic” qualifier – retained

- “endocervical adenocarcinoma in situ”- “endocervical adenocarcinoma in situ” added as a added as a discrete interpretation/diagnosis discrete interpretation/diagnosis

- “atypical endocervical cells, probably AIS”- “atypical endocervical cells, probably AIS”

- “atypical epithelial cells, NOS”- “atypical epithelial cells, NOS”

  

Endocervical Endocervical adenocarcinoma adenocarcinoma

in situin situ

Atypical endocervical cells, Atypical endocervical cells, favor neoplasticfavor neoplastic

Atypical endocervical cells,Atypical endocervical cells,NOSNOS

Atypical endometrial cells, Atypical endometrial cells, NOSNOS

ATYPICAL GLANDULAR CELLSATYPICAL GLANDULAR CELLS

Rates should be less than 1%Rates should be less than 1%

Endocervical Endocervical adenocarcinomaadenocarcinoma

Endometrial Endometrial adenocarcinomaadenocarcinoma

Extrauterine Extrauterine adenocarcinomaadenocarcinoma

Other Malignant NeoplasmsOther Malignant Neoplasms

HORMONAL EVALUATIONHORMONAL EVALUATION

crude measure of estrogen-like effect on crude measure of estrogen-like effect on squamous cellssquamous cellsnot reproduciblenot reproducibledoes not correlate with symptoms or does not correlate with symptoms or plasma estrogen levelsplasma estrogen levelsrequire a separate vaginal wall smearrequire a separate vaginal wall smearoften inappropriately requested on often inappropriately requested on cervical specimenscervical specimensrequests are rarely accompanied by requests are rarely accompanied by appropriate clinical informationappropriate clinical information

HORMONAL EVALUATIONHORMONAL EVALUATION

deleteddeleted

practitioners should be discouraged practitioners should be discouraged from using this crude evaluation in from using this crude evaluation in clinical practiceclinical practice

estrogen effect should not be used estrogen effect should not be used within the context of the within the context of the cervical/vaginal cytology screening cervical/vaginal cytology screening reportreport

RECOMMENDATIONS, RECOMMENDATIONS, EDUCATIONAL NOTES AND EDUCATIONAL NOTES AND

DISCLAIMERSDISCLAIMERS optionaloptional

should be directed by the laboratory should be directed by the laboratory to the provider who requested the to the provider who requested the testtest

should be concise and consistent should be concise and consistent with clinical follow-up guidelines with clinical follow-up guidelines published by professional published by professional organizations (references to relevant organizations (references to relevant publications may be included)publications may be included)

RECOMMENDATIONS, RECOMMENDATIONS, EDUCATIONAL NOTES EDUCATIONAL NOTES

AND DISCLAIMERSAND DISCLAIMERS

When appropriate:When appropriate:

when further procedures would be helpful to when further procedures would be helpful to

clarify ambiguous morphologic findingsclarify ambiguous morphologic findings

e.g. Atypical Glandular Cellse.g. Atypical Glandular CellsRecommendation: As a significant Recommendation: As a significant

percentage of patients with this percentage of patients with this interpretation have underlying high-grade interpretation have underlying high-grade squamous or glandular intraepithelial squamous or glandular intraepithelial abnormalities, further diagnostic patient abnormalities, further diagnostic patient follow-up procedures are suggested as follow-up procedures are suggested as clinically indicated. clinically indicated.

RECOMMENDATIONS, RECOMMENDATIONS, EDUCATIONAL NOTES EDUCATIONAL NOTES

AND DISCLAIMERSAND DISCLAIMERS When appropriate:When appropriate:

to improve the quality of a specimen following to improve the quality of a specimen following

one of limited adequacyone of limited adequacy

e.g. Unsatisfactory due to lack of cellular e.g. Unsatisfactory due to lack of cellular

material and air-drying artifact (in a post-material and air-drying artifact (in a post-

menopausal woman)menopausal woman)

Recommendation: A short course of estrogen Recommendation: A short course of estrogen

cream is suggested before obtaining a repeat cream is suggested before obtaining a repeat

specimen in order to induce maturation of the specimen in order to induce maturation of the

squamous epithelium.squamous epithelium.

RECOMMENDATIONS, RECOMMENDATIONS, EDUCATIONAL NOTES EDUCATIONAL NOTES

AND DISCLAIMERSAND DISCLAIMERS When appropriate:When appropriate:

to identify patients with certain interpretations to identify patients with certain interpretations

that require further triage and potential that require further triage and potential

subsequent managementsubsequent management

e.g. Endometrial cells present.e.g. Endometrial cells present.

Educational Note: Endometrial cells after age 40, Educational Note: Endometrial cells after age 40,

particularly out of phase or after menopause, may be particularly out of phase or after menopause, may be

associated with benign endometrium, hormonal associated with benign endometrium, hormonal

alterations and less commonly, endometrial/uterine alterations and less commonly, endometrial/uterine

abnormalities. Clinical correlation is recommended.abnormalities. Clinical correlation is recommended.

AUTOMATED REVIEWAUTOMATED REVIEW

Computer-assisted cervical cytology Computer-assisted cervical cytology interpretationinterpretation

Instrumentation used and result Instrumentation used and result should be specified in the reportshould be specified in the report

Name/s of cytotechnologist and/or Name/s of cytotechnologist and/or pathologistpathologist

Raw dataRaw data Data verificationData verification

ANCILLARY TESTINGANCILLARY TESTING

HPV DNA Testing – PCR, ISH, Hybrid HPV DNA Testing – PCR, ISH, Hybrid CaptureCapture

Specific or multiple HPV typesSpecific or multiple HPV types Differing sensitivity and specificityDiffering sensitivity and specificity Useful in the triage of women with ASCUSUseful in the triage of women with ASCUS Brief description of the methodBrief description of the method Reported in a manner conducive to clinical Reported in a manner conducive to clinical

understandingunderstanding Integrated reportIntegrated report

Thank you Thank you very much very much

for listening !for listening !