Diagnostic Accuracy of Cervical Glandular Lesions by the 2001 Bethesda System

Abstract

Objective : To analyze the diagnostic accuracy of cytologic examinations for the diagnosis of cervical  glandular lesions through the correlation between cytologic and histologic findings.

Methods : Pap smears of 35,520 women were screened according to the 2001 Bethesda criteria. In 163 cases (0.5%) were diagnosed as glandular lesions. Only 99 cases (0.3%) had histologic specimens. Histologic results were used as the gold standard for calculations of sensitivity, specificity, accuracy, positive predictive value and negative predictive value of Pap smears.

Results : Pap smears were diagnosed as atypical glandular cell (AGC) 49.5%, AGC-favor neoplasm 14.1%, adenocarcinoma in situ (AIS) 3%, adenocarcinoma (ADCA) 17.2% and the glandular with squamous lesion 16.1%. The histologic examination revealed benign cellular change (BCC) 58.6%, AIS 5.1%, ADCA 19.2%, human papillomavirus or cervical intraepithelial neoplasia 15.2% and other neoplasia 2%. The sensitivity of AGC, AGC-favor neoplasm, AIS, ADCA and mixed lesion were 72.4%, 50%, 60%, 79% and 100%, respectively. The specificity of AGC, AGC-favor neoplasm, AIS, ADCA and mixed lesion were 82.9%, 88.2%, 100%, 97.5% and 93.3%, respectively. The accuracy of AGC, AGC-favor neoplasm, AIS, ADCA and mixed lesion were 76.8%, 85.9%, 98%, 93.9% and 93.9%, respectively.

Conclusions : This study had high diagnostic accuracy more than 90% for AIS, ADCA and mixed lesion. AGC and AGC-favor neoplasm were less accurate than above lesions. The sensitivity was low in  AGC and  AGC-favor neoplasm because the histologic specimen from the small size lesion or deep location are difficulty in sampling the affected pathologic area. Although cytomorphologic criteria for diagnosis of glandular lesions have published, there was difficulty in interpreting glandular lesions. Further studies are need to increase diagnostic performance of glandular lesions.

Keywords: Pap smears, glandular lesions, the 2001 Bethesda system, sensitivity, accuracy