Jonee Matsko

Assessment of reprocessed ThinPrep cytology cases after glacial acetic acid wash procedure using the Hologic Genius Digital Diagnostics System

This study focuses on ThinPrep Pap tests with a low to borderline number of cells and the performance of AI-assisted digital systems in cases that have undergone the acetic acid wash procedure (AAW). Four hundred sixty-two cases initially interpreted as unsatisfactory and finally interpreted as satisfactory after AAW procedure were included in the study. These ThinPrep Pap slides were scanned using the Genius Digital Diagnostic System (GDDS). Overall agreement between GDDS and Original ThinPrep Interpretation (OTPI) was 63.2% for diagnostic match (Negative for Intraepithelial Lesion, ASCUS, Low Grade Squamous Intraepithelial Lesion, Atypical Squamous Cells, High Grade, Atypical Glandular Cells, or unsatisfactory), and 66.0% when ASCUS + diagnoses are grouped. Out of the 462 cases, 364 (78.8%) were called Negative for Intraepithelial Lesion based upon the manual OTPI, as opposed to 310 (67.1%) reviewed using the GDDS. There were 17.5%, 1.3%, 0.9% and 1.5% cases called Atypical Squamous Cells of Undetermined Significance, Low Grade Squamous Intraepithelial Lesion, Atypical Squamous Cells, High Grade Cannot be Excluded, and Atypical Glandular Cells respectively on OTPI, as opposed to 24.7%, 3.0%, 0.6% and 1.5% respectively by the GDDS. Only 3.0% of the cases were deemed unsatisfactory by GDDS. All the cases with high grade results in the subsequent cervical biopsy were diagnosed as at least Atypical Squamous Cells of Undetermined Significance and above by the GDDS. The diagnostic agreement between GDDS and biopsy was 65.2% compared to 58.7% for OTPI, although this is not statistically significantly different, (χ Our results demonstrate that the GDDS can be successfully used to screen ThinPrep Pap Tests that have undergone the AAW procedure.

The clinical significance of atypical glandular cells in Papanicolaou tests: changes in diagnostic patterns over 15 years at a single institution

Detection of atypical glandular cells (AGCs) by Papanicolaou (Pap) test remains a significant challenge in gynecological cytology. We compared follow-up diagnoses, age groups, and human papillomavirus (HPV) results for AGC at our institution to that of our previous study (study period 2008-2013). AGC Paps diagnosed and HPV results between January 2020 and June 2024 were obtained from the database at UPMC Magee-Womens Hospital. Of the total 188,320 Paps performed during the study period, 1025 had AGC diagnoses comprising 0.54% of the total. A total of 92.2% of cases had a companion HPV test, with positive HPV results seen in 32.9% of cases. Overall, 33.3% (286/859) of AGC cases had subsequent significant histologic findings (cervical intraepithelial neoplasia 2 and 3, adenocarcinoma in-situ, endocervical adenocarcinoma, endometrial lesions, metastatic carcinoma). Detection of cervical lesions was highest in women <30 years (50%) and significantly decreased with increasing age (P < 0.0001). Identification of endometrial lesions was highest in the ≥50-year group (P < 0.0001). Nearly half of AGC/HPV-positive cases had significant cervical findings, while these were detected in only 2.1% of AGC/HPV-negative cases (P < 0.0001). Endometrial lesions were identified in 25.7% of AGC/HPV-negative cases, but only in <1% of AGC/HPV-positive cases (P < 0.0001). Significant differences were identified comparing the 2 study periods: increased HPV testing (P < 0.0001), increased HPV-positivity (P = 0.0029), decreased AGC rate (P < 0.0001), and increased endometrial lesions on follow-up (P < 0.0001). Our findings continue to support HPV results and patient age as valuable data in triaging AGC. AGC/HPV-positive results frequently suggest a cervical/HPV-related lesion, often in younger patients. Conversely, AGC/HPV-negative results, especially in patients ≥50 years, support noncervical lesional origins.

Diagnostic performance of the hologic genius digital diagnostics system for low-grade squamous intraepithelial lesion (LSIL) ThinPrep papanicolaou tests

Advancements in digital imaging technology for Papanicolaou test slides, combined with artificial intelligence are driving the development and adoption of innovative computer-assisted screening methods for cervical cancer within the cytology community. Our study aimed to assess the performance of the Hologic Genius Digital Diagnostic System (HGDDS) in the interpretation of low-grade squamous intraepithelial lesions (LSIL) in ThinPrep Papanicolaou slides. As part of a validation study performed with 890 ThinPrep Papanicolaou slides using the HGDDS, a subset of 146 LSIL cases were included in this study. Performance characteristics for the detection of cervical intraepithelial neoplasia (CIN) and interobserver variability among 3 cytopathologists were assessed. On evaluation of the consensus results of the 3 cytopathologists, of the 146 LSIL Papanicolaou cases, 60.3% were interpreted as LSIL with the HGDDS. The remainder were interpreted as ASCUS (26%), ASC-H (10.3%), HSIL (2.7%), and NILM (0.7%). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting CIN1+ lesions in the ASCUS + category with the HGDDS were 100%, 25%, 97.9%, and 100%, respectively. The sensitivity, specificity, PPV, and NPV for the detection of CIN1+ lesions in the LSIL + category with the HGDDS were 74.7%, 75%, 99.1%, and 7.7%, respectively. Kendall's W coefficient was 0.792, indicating strong agreement among participating pathologists. Our study demonstrated that ThinPrep Papanicolaou tests with LSIL could be interpreted with strong agreement among pathologists and with good performance indicators when utilizing the HGDDS.