Histological Correlation of Glandular Abnormalities in Cervical Liquid-Based Cytology

Conventional Papanicolaou smear method is still commonly used for cervical cancer screening in Japan, despite the liquid-based cytology (LBC) that has become a global tendency in the world recently. One of the obstacles in the way of popularization of this method seems to be the confusion as to diagnosis upon cervical glandular lesions. We performed comparison study between LBC and conventional Papanicolaou smear about cytological diagnosis using split-sample method in 4522 patients. In 13 cases analyses, which were reported with either AGC or adenocarcinoma by either method, LBC tends to be milder than that by conventional smear, however, the credibility of LBC is considered to be near to that of conventional smear with regard to screening for glandular abnormalities. These results indicate that cervical cancer screening should shift to LBC under the enough experience and appropriate dealing with the cytological diagnosis. 1. Introduction Uterine cervical cancer is still the most commonly diagnosed cancer among women worldwide, taking second place only after breast cancer [1–4]. The incidence and mortality from cervical cancer decreased considerably in most industrial countries due to lower incidence and the introduction of screening [5, 6]. On the other hand, malignant or precancerous lesions of glandular cells in uterine cervix are increasing recently, as reported that the incidence of adenocarcinoma of Japan is 16.8% in 2009, and many studies reported higher mortality rate of cervical adenocarcinoma [7–12]. The screenings of the glandular lesions are thought to be difficult in comparison with those of the squamous epithelium type, although those early diagnoses become more important for prognosis improvement. In late years, Japan Association of Obstetricians and Gynecologists announced a standardized system of terminology reflected by the Bethesda system (TBS) and the screening of cervical lesions are being performed based on this system [13]. In this new Japanese system, increasing numbers of facilities come to use LBC, which is a global tendency, despite the premise to use conventional smears for sampling. In many reports of the comparison studies between LBC and conventional smear with clinical and histological followups, LBC is better than conventional smear in detecting biopsy-proven disease and in screening out benign abnormalities in terms of squamous lesions [14–22]. However, it still remains unclear how to evaluate the cytological diagnosis of the glandular lesion in the new system using LBC. We recently started TBS application using both