DNA image cytometry in the differential diagnosis of endocervical adenocarcinoma

BACKGROUND. The value of DNA image cytometry in the differential diagnosis of endocervical adenocarcinoma was tested on a series of 65 cases of normal endocervical cells (n = 25), inflammatory changes (n = 18), and endocervic al adenocarcinoma (n = 22). METHODS. The investigation was performed on gynecologic routine smears by u sing a television image analysis system MIAMED-DNA (Leica, Wetzlar, Germany ), combined with an automated Leica Medilux microscope. First, the Papanico laou stained specimens were rescreened, and the x/y coordinates of at least 150 endocervical nuclei were stored per case by using a scanning program. After restaining according to Feulgen, the epithelial cells were relocalize d and the DNA content, and the nuclear area were determined. The DNA conten t of 25-30 squamous epithelial cells of intermediate type served as an inte rnal standard for the normal diploid value in each case. Various DNA cytome tric parameters and the mean nuclear area were calculated. For statistical analysis, the cases of adenocarcinoma (n = 22) were defined as positive, an d the cases with normal endocervical epithelium or inflammatory changes (n = 43) were defined as negative. RESULTS. The presence of nuclei with a DNA content greater than 9c was obse rved exclusively in adenocarcinoma (sensitivity, 95.9%; specificity, 100%), indicating that this parameter is suited best for the differentiation betw een malignant and nonmalignant endocervical epithelium. High sensitivity ra tes at a specificity level of 100% also were calculated for the 2.5cER (95. 5%), the mean ploidy (90.9%), 5cER (90.9%), and the diploid deviation quoti ent (90.9%). For the 2cDI (86.4%), the entropy (81.8%) and the ploidy imbal ance (77.3%) lower values were obtained. CONCLUSIONS. DNA single cell cytometry represents a highly relevant tool in the identification of malignant transformation in endocervical lesions tha t could be used as a complementary diagnostic method in cytologically diffi cult cases. Investigations on endocervical adenocarcinoma in situ should be performed in the near future. Cancer(Cancer Cytopathol) 2001;93:160-164. ( C) 2001 American Cancer Society.