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Cytology of cervical intraepithelial glandular lesions

Ovanin-Rakić, Ana and Mahovlić, Vesna and Audy-Jurković, Silvana and Barišić, Ana and Škopljanac-Mačina, Lada and Jurič, Danijela and Rajhvajn, Sanda and Ilić-Forko, Jadranka and Babić, Damir and Folnović, Darko and Kani, Dubravka (2010) Cytology of cervical intraepithelial glandular lesions. Collegium Antropologicum, 34 (2). pp. 401-6. ISSN 0350-6134

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    Croatian abstract

    CITOLOGIJA CERVIKALNIH INTRAEPITELNIH LEZIJA CILINDRIČNOG EPITELA ----- Citološki kriteriji za identifikaciju glandularnih intraepitelnih lezija još nisu detaljno opisani, posebice za prekursore adenokarcinoma in situ (AIS) te ove lezije često nisu prepoznate. Većina bolesnica u kojih je dijagnosticiran AIS ili glandularna intraepitelna lezija (GIL) lakog i srednjeg stupnja su bez kliničkih simptoma te citologija ima vrlo odgovorno mjesto u otkrivanju ovih lezija. U svrhu postizanja što adekvatnije i točnije citološke dijagnoze intraepitelnih lezija endocervikalnog cilindričnog epitela, analizirani su citološki nalazi bolesnica u kojih su histološki verificirane glandularne intraepitelne lezije. Vrijednost citologije u otkrivanju i u diferencijalnoj dijagnozi, uzimajući u obzir težinu lezije i/ili vrstu promjenjenog epitela, testirana je u 123 bolesnice s konačnom histološkom dijagnozom intraepitelne glandularne lezije AIS (n=13), GIL I (n=11), GIL II (n=7), odnosno glandularne lezije udružene s pločastom komponentom AIS uz cervikalnu intraepitelnu leziju (CIN) i/ili invazivni karcinom pločastog epitela (IC) (n=58), GIL I ili GIL II+CIN (n=28), GIL uz mikroinvazivni pločasti karcinom (MIC) (n=6) U 95,1% lezija je otkrivena citološkom analizom koja je indicirala daljnju dijagnostičku obradu. Diferencijalno dijagnostička točnost citologije bila je viša u predviđanju težine lezije 75,6% nego vrste promjenjenog epitela 55,3% te u predskazivanju abnormalnosti pločastog 95,7% za razliku od cilindričnog epitela 74,2% Točnost citologije bila je veća za čiste lezije (AIS – 61,5%; GIL I /GIL II – 22,2%) nego za miješane lezije (25,9% i 20,6%). Kontinuirano poboljšanje cervikalnih razmaza i citodijagnostičkih vještina, bolje razumijevanje i definiranje predstadija intraepitelnog adenokarcinoma i njihovo uključivanje u citološku i patohistološku klasifikaciju lezija vrata maternice, moralo bi rezultirati boljom detekcijom i dijagnostikom glandularnih intraepitelnih lezija te smanjenjem morbiditeta i mortaliteta od invazivnog cervikalnog adenokarcinoma.

    English abstract

    Cytological criteria for the identification of glandular intraepithelial lesions (GIL) have not yet been fully described, especially for the precursors of adenocarcinoma in situ (AIS), thus these lesions may frequently remain unrecognized. As most patients diagnosed with AIS or mild to moderate GIL (grades I, II) are free from clinical symptoms, cytology has a very responsible role in the detection of these lesions. The aim of the study was to achieve the most appropriate cytologic diagnosis of intraepithelial lesions of endocervical columnar epithelium, analyzing the cytology findings in patients with histologically verified AIS and GIL (I, II). The value of cytology in the detection and differential diagnosis was assessed in 123 patients with definitive histologic diagnosis of glandular lesions (AIS, n = 13; GIL I, n = 11; and GIL II, n = 7), and glandular lesions associated with squamous component (AIS associated with cervical intraepithelial neoplasia (CIN) or invasive squamous cell carcinoma (SCC), n = 58; GIL I or GIL II associated with CIN, n = 28; and GIL associated with microinvasive squamous carcinoma (MIC), n = 6). In 95.1% of patients, lesions were detected by cytologic analysis that indicated additional diagnostic procedure. In terms of differential diagnosis, cytology showed higher accuracy in predicting lesion severity vs. type of epithelial alteration (75.6% vs. 55.3%) and abnormalities of columnar epithelium (95.7%; vs. 74.2%). The accuracy of cytology was higher in pure (AIS, 61.5% and GIL I, II, 22.2%) than in mixed lesions (25.9% and 20.6%). Continuous improvement in cervical specimens and cytodiagnostic skills, better understanding of intraepithelial adenocarcinoma and precursors, and their inclusion in the classification of cytologic and histologic findings are expected to upgrade the detection of these lesions, and to reduce the invasive cervical adenocarcinoma morbidity and mortality.

    Item Type: Article
    MeSH: Adenocarcinoma/pathology ; Adult ; Carcinoma in Situ/pathology ; Carcinoma, Squamous Cell/pathology ; Cervical Intraepithelial Neoplasia/pathology ; Diagnosis, Differential ; Female ; Humans ; Neoplasm Invasiveness ; Neoplasm Staging ; Vaginal Smears
    Divisions: Katedra za patologiju
    Depositing User: Marijan Šember
    Status: Published
    Creators:
    CreatorsEmail
    Ovanin-Rakić, Ana
    Mahovlić, Vesna
    Audy-Jurković, Silvana
    Barišić, Ana
    Škopljanac-Mačina, Lada
    Jurič, Danijela
    Rajhvajn, Sanda
    Ilić-Forko, Jadranka
    Babić, Damir
    Folnović, Darko
    Kani, Dubravka
    Date: June 2010
    Date Deposited: 26 Nov 2010
    Last Modified: 23 Sep 2011 18:11
    Subjects: /
    Related URLs:
      URI: http://medlib.mef.hr/id/eprint/901

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