The role of cervical cytology and colposcopy in detecting cervical glandular neoplasia.
OBJECTIVE
To determine the role of cervical cytology and colposcopy in the management of endocervical neoplasia.


METHODS
Colposcopy unit and cytology laboratory in a teaching hospital.


METHODS
Group 1 included 184 smears showing endocervical glandular neoplasia from 129 patients and group 2 included 101 patients with histology showing endocervical abnormalities in a 6-year period (1993-1998). Follow-up of 6-11 years to 2004 was available.


METHODS
Group 1 were identified from the cytology computer records. Group 2 were identified from histology records on the cytology database and a record of histology cases kept for audit purposes. The clinical records were examined retrospectively.


RESULTS
The positive predictive value (PPV) of abnormal endocervical cells in smears was 81.1% for significant glandular/squamous [cervical glandular intraepithelial neoplasia (CGIN)/cervical intraepithelial neoplasia grade2 (CIN2 or worse)] lesions. The PPV of colposcopy was 93.5% for significant glandular/squamous lesions of the cervix. The postcolposcopy probability of a significant lesion when colposcopy was normal was 87.5%. The sensitivity of colposcopy in detecting endocervical lesions was 9.8%. The sensitivity of cervical smears in detecting a significant endocervical abnormality (CGIN or worse) was 66.3%. The false negative rate for cytology of endocervical glandular lesions was 4.0%.


CONCLUSIONS
Endocervical glandular neoplasia detected on cytology is predictive of significant cervical pathology even when colposcopy is normal, which supports excisional biopsy in the primary assessment of these smears. The high concomitant squamous abnormality rate justifies the use of colposcopy to direct biopsies from the ectocervix. Cervical cytology is the only current screening method for cervical glandular abnormalities but sensitivity is poor.
Department of Obstetrics and Gynaecology, Royal Victoria Infirmary, Newcastle-upon-Tyne NE1 4LP, UK. aartiullal@doctors.org.uk
A
A
Ullal
M
M
Roberts
J N
JN
Bulmer
M E
ME
Mathers
V
V
Wadehra
D001706:Biopsy / Q000379:methods; D002584:Cervix Uteri / Q000473:pathology*; D003127:Colposcopy / Q000379:methods*; D003584:Cytological Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D009375:Neoplasms, Glandular and Epithelial / Q000175:diagnosis / Q000473:pathology; D011230:Precancerous Conditions / Q000175:diagnosis / Q000473:pathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000473:pathology; D014626:Vaginal Smears