CYTOLOGIC FEATURES OF NEOPLASTIC LESIONS IN ENDOCERVICAL GLANDS

Cytologic criteria for classifying atypical endocervical cells on Pap smears are poorly defined. In this study we evaluated cytologic parame ter that are useful in predicting the presence of neoplastic lesions ( NL) and those that help distinguish squamous intraepithelial lesion (S IL) from glandular neoplastic lesions. The recently proposed Bethesda System (TBS) terminology for reporting atypical glandular cells of und etermined significance (AGUS) was also evaluated for its significance on patient management. Sixteen cases of biopsy-proven endocervical gla ndular NL that had cytologic smears available for review were included . Thirty-five smears with atypical endocervical cells and follow-up bi opsies showing benign/reactive change (n = 22) and SIL involving gland s (n = 13) were reviewed for comparison. Our results show that squamou s NL often coexist with glandular NL. The presence of rosettes, hyperc hromasia, and increased N/C ratio is useful in distinguishing NL from benign/reactive conditions. Architectural features are helpful in dist inguishing SIL from glandular NL. While a haphazard arrangement is mor e often seen with SIL, glandular NL are more likely to maintain polari ty and to show glandular rosettes. Using TBS criteria, a conservative management seems justified in patients with AGUS-favor reactive and AG US diagnosis on Pap smear, and colposcopy is indicated for patients wi th AGUS-favor NL. (C) 1997 Wiley-Liss, Inc.