PART TWO
Diagnostic Cytology
biopsy, recent colposcopic biopsy, or the current presence of an
endocervical polyp. Knowledge of such clinical information can
assist when cytologic differentials involve direct endometrial
sampling or reactive changes. For laboratory quality assurance
of equivocal glandular cytology specimens, monitoring of the
AGC interpretation prevalence rate is important. As mentioned
earlier, AGC prevalence is generally low, less than 0.5% of total
specimens. Where prevalence rates are substantially higher than
this level, reasons should be sought for such deviations. Causes
might include overinterpretation of glandular lesions; however,
there are valid explanations for increased prevalence, such as the
taking on of a high-risk clinic specializing in the management
of such lesions. Other useful quality assurance and continuing
education activities include cytology-histology correlation for
all such cases and consensus conference review. Fine tuning of
criteria and standardization of practice using group review of
these generally rare lesions is an excellent method for ensuring
optimal quality of ongoing interpretation.
Concluding Remarks
Endocervical glandular neoplastic lesions are growing in impor-
tance in the practice of gynecologic cytology. Incidence of this
disease has grown over the past 50 years, most likely secondary
to changes in hormone usage and other, as yet unknown, risk
factors. Improved methods of upper endocervical canal sam-
pling, as well as refinements in cytologic criteria which have
led to more reliable identification and prediction of disease,
have been implemented. This chapter has detailed those mor-
phologic features necessary for cytologic detection of glandular
lesions. It has also detailed the expanded differential diagnosis
of benign mimickers brought about by more thorough sampling
procedures. The reader is left with one final caveat for success-
ful discrimination of these difficult but important differential
diagnoses. When considering an endocervical glandular lesion,
the observer must "push back from the microscope" and do two
things:
(1) Consider all the conditions that may fall into this
differential diagnosis—methodically go through all
the differential morphologic features noted above
that favor or militate against each entity, both benign
and neoplastic; and
(2) Gather all associated clinical information regarding
the patient—review of this material can very often
provide important clues to the ultimate diagnosis.
Adherence to this routine can provide the cytologist with opti-
mal specificity and will ultimately serve to provide the best
patient care and safety possible.
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