Endocervical Glandular Involvement is Associated with an Increased Detection Rate of High-Grade Squamous Intraepithelial Lesions on the Pap Test

Abstract Introduction Although The Bethesda System for Reporting Cervical Cytopathology does not mandate reporting of endocervical glandular involvement (EGI) in Pap test specimens with high-grade squamous intraepithelial lesions (HSIL), several studies have suggested that EGI diagnosed on surgical specimens is associated with higher rates of residual or recurrent dysplasia. When suspected, EGI is reported for Pap test specimens at our institution, but the performance of this diagnosis has not been assessed. Methods The archives were queried for Pap test specimens with a diagnosis of HSIL-EGI (2006-2017). All follow up surgical pathology specimens within a year of the Pap test diagnosis were evaluated for cytologic-histologic correlation. This same query was repeated for all surgical pathology specimens with a diagnosis of HSIL-EGI. All preceding Pap test diagnoses within a year were assessed for cytologic-histologic correlation. Twenty Pap test specimen glass slides were reviewed by 6 observers to assess for interobserver variability. Results Patients with HSIL-EGI on surgical specimens were more likely to have a preceding Pap diagnosis of HSIL and ASC-H (32.3% vs. 25.5%, P = 0.03 and 16.7% vs. 11.8%, P = 0.04, respectively). Patients with an HSIL-EGI diagnosis on a Pap test were significantly more likely to have HSIL-EGI detected on a follow up histology (41.6% vs 24.0%, P Conclusion Overall, the diagnosis of HSIL-EGI on Pap test specimens is complicated by poor sensitivity and interobserver concordance.