Individual use of cytomorphologic characteristics in the diagnosis of endocervical columnar cell abnormalities: selection of preferred features with help of the 'Navigator' microscope.
In our previous interobserver studies on endocervical columnar cell abnormalities, we studied architectural, cellular and nuclear features in cervical smears of women known to have columnar cell atypias of variable severity, to determine cytomorphologic criteria, discriminating between mild, moderate and severe intraepithelial columnar cell lesions and adenocarcinoma. The results of these studies revealed a number of architectural, cellular and nuclear characteristics in different grades of expression, which were of importance for the primary diagnosis of: no abnormalities, different grades of intraepithelial endocervical columnar cell lesions and adenocarcinoma. Furthermore we concluded that observers used different characteristics and different grades of expression of these characteristics for comparable diagnoses. The present study was undertaken to determine those features, which were considered discriminating by each individual for the diagnosis of mild, moderate and severe atypia, adenocarcinoma in situ and adenocarcinoma. Features selected by five observers with knowledge of the final diagnosis, were stored and reviewed with help of a motor driven stage ('Navigator')-microscope and a high definition television-monitor. The results confirmed individual observer variability in the number and type of features used in the diagnosis of endocervical columnar cell abnormalities. Features such as 'variation in nuclear size and shape', 'irregular chromatin distribution' and 'coarsely granular chromatin' were selected preferentially by all observers in the diagnosis of endocervical columnar cell lesions, conversely striking differences were observed in the application of 'architectural'-and, especially in cases of 'adenocarcinoma', 'nucleolar' characteristics.
van Aspert van Erp
A J
AJ
Faculty of Medical Sciences, University of Nijmegen, The Netherlands.
van't Hof Grootenboer
A E
AE
Brugal
G
G
Vooijs
G P
GP
D000230:Adenocarcinoma / Q000473:pathology; D002278:Carcinoma in Situ / Q000473:pathology; D002584:Cervix Uteri / Q000473:pathology*; D004848:Epithelium / Q000473:pathology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008853:Microscopy / Q000379:methods*; D018715:Microscopy, Video / Q000379:methods; D009092:Mucous Membrane / Q000473:pathology; D015588:Observer Variation; D012189:Retrospective Studies; D002578:Uterine Cervical Dysplasia / Q000473:pathology*; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D014626:Vaginal Smears / Q000379:methods