Application of cytomorphologic features and immunocytochemistry to cervicovaginal smears. A scoring system to distinguish between endometrial and endocervical adenocarcinoma.
OBJECTIVE
To apply cytomorphologic features and a limited panel of immunocytochemistry to cervicovaginal smears to distinguish between primary endocervical adenocarcinoma (ECA) and primary endometrial adenocarcinoma (EMC).


METHODS
The study was a retrospective analysis of 35 cases, of which 21 were of primary endometrial origin and 14 were of primary endocervical origin. In all cases included in the study, the site of origin of adenocarcinoma was confirmed by examination of the surgical specimen. Twenty-four cytomorphologic characteristics and a limited panel of antibodies (estrogen receptor, carcinoembryonic antigen and vimentin) were applied to conventional cervicovaginal smears to ascertain whether a combination of these would be sufficiently distinctive to allow reliable distinction between ECA and EMC. The slides were scored using defined cytomorphologic characteristics and immunocytochemistry. The score was calculated by using the receiver operating curve (ROC).


RESULTS
Statistical analysis identified 7 variables that were significant in distinguishing between ECA and EMC: necrosis, altered blood, histiocytes, strips of cells, palisading of cells, pseudorosettes and positive immunocytochemical staining for carcinoembryonic antigen. Using the ROC, a numerical score < 4 was indicative of an EMC and a score > or = 4 of ECA.


CONCLUSIONS
This study found that the proposed scoring system based on these 7 variables could reliably distinguish between ECA and EMC and assist in definitive management of patients.
Schroeter
Leocardea
L
Division of Anatomical Pathology, Department of Pathology, University of Stellenbosch and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa. leocardea@mweb.co.za
Louw
Mercia
M
Michelow
Pamela
P
Wright
Colleen
C
D002272:Carcinoembryonic Antigen / Q000378:metabolism; D003937:Diagnosis, Differential; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D012372:ROC Curve; D012107:Research Design; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D014626:Vaginal Smears / Q000379:methods*
D002272:Carcinoembryonic Antigen