Journal of the American Society of Cytopathology · 2025
Acidic alterations: impact of glacial acetic acid treatment on interpretations of atypical endocervical and atypical glandular cells, not otherwise specified in Pap tests.
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Marsden Katharine A, Wilkinson Zachary A, Dyhdalo Kathryn S, Hoda Raza S
Аннотация
INTRODUCTION: Glacial acetic acid (GAA) is used in ThinPrep Pap tests to clear excess blood, but it may alter glandular cell appearance, particularly that of endocervical cells, potentially increasing false-positive interpretations. This may be countered by increased awareness of these cytologic alterations.
MATERIALS AND METHODS: We retrospectively analyzed all cervical and vaginal Pap tests from 2018 to 2022, comparing rates of "Atypical Endocervical Cells" (AEC) and "Atypical Glandular Cells, Not Otherwise Specified" (AGC) interpretations in GAA-treated and untreated Pap tests. Human papillomavirus status and histologic follow-up within 1 year were recorded for GAA-treated Pap tests. Histologic follow-up for a GAA-untreated control group was recorded.
RESULTS: AGC and AEC interpretations were significantly more frequent in GAA-treated Pap tests compared to untreated tests (AGC, 39/7004 versus 85/258,185, respectively; AEC, 34/7004 GAA-treated Pap tests versus 417/258,185 untreated Pap tests; P < 0.0001 for both). For GAA-treated tests with AGC interpretations, age was significantly associated with a malignant histologic outcome (P < 0.001), while no such association was observed for those with AEC interpretations (P = 0.19). Malignant histologic follow-up was significantly lower in GAA-treated group with AEC interpretation compared to control group (P < 0.001), and no significant difference was seen in malignant histologic follow-up for GAA-treated and control group with AGC interpretation (P = 0.61).
CONCLUSIONS: GAA-treated Pap tests showed significantly higher rates of AGC and AEC interpretations compared to untreated tests. Additional follow-up may be warranted for patients with GAA-treated Pap tests and AGC interpretations, particularly in older patients.
MATERIALS AND METHODS: We retrospectively analyzed all cervical and vaginal Pap tests from 2018 to 2022, comparing rates of "Atypical Endocervical Cells" (AEC) and "Atypical Glandular Cells, Not Otherwise Specified" (AGC) interpretations in GAA-treated and untreated Pap tests. Human papillomavirus status and histologic follow-up within 1 year were recorded for GAA-treated Pap tests. Histologic follow-up for a GAA-untreated control group was recorded.
RESULTS: AGC and AEC interpretations were significantly more frequent in GAA-treated Pap tests compared to untreated tests (AGC, 39/7004 versus 85/258,185, respectively; AEC, 34/7004 GAA-treated Pap tests versus 417/258,185 untreated Pap tests; P < 0.0001 for both). For GAA-treated tests with AGC interpretations, age was significantly associated with a malignant histologic outcome (P < 0.001), while no such association was observed for those with AEC interpretations (P = 0.19). Malignant histologic follow-up was significantly lower in GAA-treated group with AEC interpretation compared to control group (P < 0.001), and no significant difference was seen in malignant histologic follow-up for GAA-treated and control group with AGC interpretation (P = 0.61).
CONCLUSIONS: GAA-treated Pap tests showed significantly higher rates of AGC and AEC interpretations compared to untreated tests. Additional follow-up may be warranted for patients with GAA-treated Pap tests and AGC interpretations, particularly in older patients.