2016 myresearch Science Internship Program: Laboratory Medicine. Civic Education Office of Government and Community Relations

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1 2016 myresearch Science Internship Program: Laboratory Medicine Civic Education Office of Government and Community Relations

2 Aliya Ansari Science Internship Program: Laboratory Medicine

3 Cytologic Differentiation Between Benign and Malignant Atypia in Endometrial Cells Aliya Ansari Sandra E. Dolar, SCT (ASCP) CM Paul Suchy, DM, MSM

4 Abstract The Pap test successfully reduces the number of squamous cell carcinomas through early detection of precursor cell changes. This screening method was not intended to detect non-cervical cancers such as well-differentiated adenocarcinoma of the endometrium.

5 Abstract (cont.) Exfoliated endometrial cells may appear on Pap tests, and cytotechnologists need to evaluate cell changes to maximize detection of any abnormalities. Benign and malignant cytologic criteria in these endometrial fragments can be overlapping, and may lead to unnecessary, invasive surgical procedures.

6 Background Normal endometrial cells (400x) Benign atypical endometrial cells (400x) Well-differentiated adenocarcinoma (400x) Poorly-differentiated adenocarcinoma (400x)

7 Problem/Purpose To analyze the cellular features of atypical endometrial cells. To determine if there exist specific indicators that will refine cervical screening criteria for cytotechnologists. To aid in the differentiation between benign and malignant endometrial atypia.

8 Hypothesis The majority of atypical endometrial cells seen in cytologic cases that undergo surgical procedures will have final diagnoses of leiomyomas, benign hyperplasias, or proliferative/secretory endometrium rather than malignancy.

9 Methodology 159 Pap tests containing atypical endometrial cells for the year 2011 at Cleveland Clinic s main campus were selected. Case number, patient age, clinical history, surgical number, surgical site, and final diagnosis were recorded.

10 Methodology (cont.) De-identified cases were analyzed to determine clinical history distribution and frequency of patients with atypia having benign or malignant final diagnosis. Benign and malignant cases were microscopically examined for potential cytologic differences.

11 Data Clinical History Distribution Clinical History Number of Cases Percentage of All Cases Studied % % % % % Mean Patient Age 47.1 (30-70) 64.1 (53-87) 48.9 (37-75) 43.7 (17-58) 50 (45-55) Cases of Adenocarcinoma Clinical History Key No significant clinical history Postmenopausal/ postmenopausal bleeding Reflex HPV testing for ASCUS 1 Abnormal bleeding 0 IUD % 54.8 (32-86) 2 Previous abdominal surgery

12 Data (cont.)

13 Results 97 (61.0%) of 159 cases had some significant clinical history. Of 33 cases with surgical follow-up of adenocarcinoma, 24 (72.7%) had a status of being either postmenopausal or postmenopausal with bleeding.

14 Results (cont.) 56 (67.5%) of 83 benign cases had at least one piece of clinical information that may have contributed to the original atypical diagnosis. Microscopically, no consistent cytologic differences between atypical and well-differentiated malignant endometrial cells were noted.

15 Conclusions The majority (n=103, 64.8%) of atypia seen in the endometrium is diagnosed as benign or hyperplastic, which supports my hypothesis. There is positive correlation between increasing age or significant clinical history and malignant final diagnosis.

16 Conclusions (cont.) Currently, screening criteria cannot be refined due to a lack of cytologic variation between benign and welldifferentiated malignant atypia in endometrial cells. Cytotechnologists are currently unable to accurately diagnose atypical endometrial cells as benign or malignant due to this lack of variation.

17 Recommendations The study should be expanded to examine more cases and obtain more statistical data. Changes should not be made to current cytotechnologist curriculum and screening criteria until further studies have been conducted. Clinical history correlation should be further studied.

18 References Birdsong, George G., and Diane Davis Davey. "Specimen Adequacy." The Bethesda System for Reporting Cervical Cytology: Definitions, Criteria, and Explanatory Notes. 3rd ed. New York: Springer, Print. DeMay, Richard M. "Cytology of the Glandular Epithelium." The Pap Test. Chicago: ASCP, Print. Staats, Paul N., Nancy A. Young, Marluce Bibbo, Terrence J. Colgan, and Marianne U. Prey. "Non-Neoplastic Findings." The Bethesda System for Reporting Cervical Cytology: Definitions, Criteria, and Explanatory Notes. By Daniel F.I. Kurtcyz and Ritu Nayar. 3rd ed. New York: Springer, Print.

19 Special Thanks My mentor, Sandra E. Dolar, SCT (ASCP) CM My co-mentor, Paul Suchy, DM, MSM Nedra Starling, MA, MPH, ABD/DrPH Cleveland Clinic Office of Government and Community Relations Department of Civic Education

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