title: ProExC triage of atypical glandular cells on liquid-based cervical cytology specimens.
abstract: OBJECTIVE
  Morphologic distinction between atypical glandular cells not otherwise specified (AGC-NOS) and AGC-favor neoplasia (AGC-FN) can be difficult. Distinction between these entities is important as the American Society for Colposcopy and Cervical Pathology 2006 consensus guidelines state that management of AGC-NOS differs from that of AGC-FN. The objective of this study was to determine the potential role of ProExC immunocytochemical triage of AGC-NOS.
  
  
  METHODS
  Cytopathology records from a pathology practice were reviewed from January 2006 to December 2009 to identify AGC-NOS liquid-based Pap smears with subsequent biopsy correlation. Archival slides were examined, and ProExC immunocytochemistry was performed. The AGC groups were assessed for nuclear staining, and results were correlated with subsequent biopsy findings.
  
  
  RESULTS
  Twenty-eight AGC-NOS cases with biopsy correlation were identified: 13 with subsequent high-grade neoplastic or malignant (positive) diagnoses and 15 with benign diagnoses. Of 13 AGC-NOS cases with positive diagnosis, 10 were ProExC-positive and 3 were ProExC-negative (metastatic tumors from distant sites). Of 15 AGC cases with benign follow-up, 13 were ProExC-negative and 2 were ProExC-positive (sensitivity, 77%; specificity, 87%). For patients with cervical intraepithelial neoplasia or carcinoma originating from the female genital tract, 100% (10/10) were ProExC-positive (sensitivity, 100%; specificity, 87%).
  
  
  CONCLUSIONS
  Results suggest that ProExC-positive AGC-NOS may be classified as AGC-FN. Although positive immunocytochemical staining for ProExC requires management similar to AGC-FN, negative staining does not rule out malignancy such as metastatic tumor. Management for ProExC-negative AGC-NOS cases should proceed according to the current guidelines for AGC-NOS.
authors.affiliation: Watauga Pathology Associates, Johnson City, TN 37604, USA. fletcherah@msha.com
authors.forename: Andrew Hamilton
authors.initials: AH
authors.lastname: Fletcher
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Barklow
authors.forename: Nina J
authors.initials: NJ
authors.lastname: Murphy
authors.forename: Leah H
authors.initials: LH
authors.lastname: Culbertson
authors.forename: Angie V
authors.initials: AV
authors.lastname: Davis
authors.forename: Louise
authors.initials: L
authors.lastname: Hunter
mesh_terms: D000328:Adult; D000368:Aged; D000951:Antigens, Neoplasm / Q000032:analysis*; D001706:Biopsy; D018797:Cell Cycle Proteins / Q000032:analysis*; D002584:Cervix Uteri / Q000473:pathology*; D003584:Cytological Techniques / Q000379:methods; D004250:DNA Topoisomerases, Type II / Q000032:analysis*; D004268:DNA-Binding Proteins / Q000032:analysis*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D008875:Middle Aged; D064111:Minichromosome Maintenance Complex Component 2; D009687:Nuclear Proteins / Q000032:analysis*; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000473:pathology; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology
chemical_list: D000951:Antigens, Neoplasm; D018797:Cell Cycle Proteins; D004268:DNA-Binding Proteins; D009687:Nuclear Proteins; C084859:MCM2 protein, human; D064111:Minichromosome Maintenance Complex Component 2; D004250:DNA Topoisomerases, Type II