Papanicolaou tests with coexisting squamous and glandular abnormalities

Papanicolaou (Pap) test interpretations of atypical glandular cells are associated with subsequent detection of squamous and, less often, glandular malignancies. A Pap test with a combined interpretation of squamous and glandular atypia indicates concern for either 2 distinct lesions (both squamous and glandular) or involvement of cervical squamous and glandular epithelium by a single pathologic process. Dual interpretations can potentially guide patient management. This retrospective study describes an institutional experience with Pap test dual reporting of squamous and glandular atypia and patient follow-up in these cases.

Following institutional review board approval, a search of the anatomic pathology database for Pap tests with both atypical squamous and atypical glandular interpretations from January 2005 to December 2010 was performed. Other recorded data included: prior history, age, human papillomavirus (HPV) status, and most severe follow-up histologic diagnosis.

Of 361,953 Pap tests interpreted in the laboratory during this period, a total of 230 (0.06%) patients with dual interpretation Pap tests and follow-up were identified. Follow-up pathology results on these patients were predominantly squamous lesions (51.7%). Glandular lesions only were detected in 14 cases (6.1%). Nine (3.9%) patients had both squamous and glandular pathology.

Over a 6-year period, dual Pap test interpretations with both squamous and glandular atypia were more often associated with squamous than glandular lesions. Dual interpretations did identify coexisting squamous and glandular lesions. However, the number of cases was small.