OBJECTIVE: To identify specific cytomorphologic characteristics of mild, moderate and severe atypia of endocervical columnar cell lesions. STUDY DESIGN: The study group consisted of 55 smears from 53 women known to have columnar cell atypias of variable severity. The smears were reviewed by five observers in terms of 46 architectural, cellular and nuclear features. Review diagnoses were given together with the scoring for a large number of cellular characteristics. RESULTS: Nuclear chromatin distribution, variation in cellular and nuclear size, cytoplasmic eosinophilia and such architectural features as cell crowding, cluster formation, formation of gland-like structures and pseudostratification appeared to be of primary diagnostic importance for discriminating between no abnormalities, different grades of severity of endocervical intraepithelial neoplasia and adenocarcinoma. With acceptance of one grade of difference in grades of severity, a correct diagnosis was made in 87.6% of cases. CONCLUSION: With the application of specific architectural, cellular and nuclear features, the cytologic detection of different grades of endocervical intraepithelial neoplasia and of adenocarcinoma proved to be dependable and reproducible, with accuracy that at least equaled that of detecting squamous (metaplastic) lesions.
OBJECTIVE: To identify specific cytomorphologic characteristics of mild, moderate and severe atypia of endocervical columnar cell lesions. STUDY DESIGN: The study group consisted of 55 smears from 53 women known to have columnar cell atypias of variable severity. The smears were reviewed by five observers in terms of 46 architectural, cellular and nuclear features. Review diagnoses were given together with the scoring for a large number of cellular characteristics. RESULTS: Nuclear chromatin distribution, variation in cellular and nuclear size, cytoplasmic eosinophilia and such architectural features as cell crowding, cluster formation, formation of gland-like structures and pseudostratification appeared to be of primary diagnostic importance for discriminating between no abnormalities, different grades of severity of endocervical intraepithelial neoplasia and adenocarcinoma. With acceptance of one grade of difference in grades of severity, a correct diagnosis was made in 87.6% of cases. CONCLUSION: With the application of specific architectural, cellular and nuclear features, the cytologic detection of different grades of endocervical intraepithelial neoplasia and of adenocarcinoma proved to be dependable and reproducible, with accuracy that at least equaled that of detecting squamous (metaplastic) lesions.