Cytohistological correlation of endocervical gland involvement with high-grade squamous intraepithelial lesions

Diagnosis of endocervical glandular involvement by high-grade squamous intraepithelial lesion (HSIL-EGI) on Papanicolaou (Pap) smears can affect the clinical management of patients.

The cytological criteria for the diagnosis of HSIL-EGI are described and the accuracy of this diagnosis was investigated.

Seventeen patients diagnosed with HSIL-EGI and 40 patients with diagnosis of HSIL on Pap smears with follow-up cone or loop electrocautery excision procedure (LEEP) biopsies were included in the study. The following criteria were evaluated for the cytological diagnosis of HSIL-EGI: atypical cells with definite features of HSIL, three-dimensional atypical squamous cell clusters (TDCs) with attached benign endocervical epithelium, finger-like TDCs covered with intact epithelium on most sides, which represent the finger-like invaginations of the endocervical glandular area involved by HSIL, and the absence of cytological findings of in situ adenocarcinoma of the cervix.

On subsequent histopathological evaluation, 16 of 17 (94.1%) patients with a cytological diagnosis of HSIL-EGI and 17 of 40 (42.5%) patients with HSIL exhibited endocervical glandular involvement (P < 0.001, sensitivity: 48.5%, specificity: 95.8%, positive predictive value: 94.1%, negative predictive value: 57.5% and accuracy: 68.4%).

Diagnosis of HSIL-EGI may be possible on Pap smears with a high positive predictive value and specificity but low sensitivity, possibly due to cytological sampling limitations. To clarify the results of the present study, more extensive studies with a particular emphasis on the sampling of the endocervical glandular area for cytological evaluation of the cervix are needed.