Papanicolaou tests with coexisting squamous and glandular abnormalities

Area of Science:

• Cytopathology
• Gynecologic Pathology
• Cervical Cancer Screening

Background:

• Atypical glandular cell (AGC) interpretations on Papanicolaou (Pap) tests are linked to squamous and glandular malignancies.
• Dual Pap test interpretations (squamous and glandular atypia) suggest either two distinct lesions or a single process affecting both epithelia.
• Dual interpretations may inform patient management strategies.

Purpose of the Study:

• To retrospectively analyze institutional experience with dual Pap test reporting of squamous and glandular atypia.
• To evaluate patient follow-up outcomes associated with these dual interpretations.

Main Methods:

• Retrospective search of anatomic pathology database (January 2005 - December 2010).
• Identified Pap tests with concurrent atypical squamous and atypical glandular interpretations.
• Collected data on prior history, age, human papillomavirus (HPV) status, and follow-up histologic diagnoses.

Main Results:

• 230 cases (0.06%) with dual interpretation Pap tests and follow-up were identified out of 361,953 total Pap tests.
• Follow-up pathology predominantly revealed squamous lesions (51.7%).
• Glandular lesions alone occurred in 6.1% of cases, and both squamous and glandular pathology in 3.9%.

Conclusions:

• Dual Pap test interpretations of squamous and glandular atypia were more commonly associated with squamous lesions over a 6-year period.
• These dual interpretations successfully identified coexisting squamous and glandular lesions.
• The overall number of cases with dual interpretations was small.