Investigator
University Of Pittsburgh Medical Center
Assessment of the efficiency and accuracy of an artificial intelligence assistive system in the diagnosis of Pap cervical atypical glandular cell cytology
Abstract Background A diagnosis of atypical glandular cells (AGC) on Papanicolaou (Pap) slides is rare but has clinically significant findings associated with high‐risk cervical and endometrial lesions. The authors evaluated the efficiency and diagnostic performance of an artificial intelligence (AI)‐assisted platform (Riuqian WSI‐2400; with the registered trademark AICyte) in identifying AGCs on Pap slides. Methods A retrospective analysis of 485 Pap cases was conducted, including 185 cases with AGCs, 50 cases with high‐grade squamous intraepithelial lesions, 50 cases with low‐grade squamous intraepithelial lesions, and 200 negative cases; of these, 264 cases had histologic correlations. An experienced cytopathologist reviewed all slides using conventional microscopy and AICyte. Then, the same cases were evaluated by two other pathologists using the AICyte system. Results The initial study demonstrated a kappa value of 0.744, which indicated strong agreement of the Pap interpretation from the same pathologist between using microscopy and AICyte methods, whereas the average interpretation time was significantly reduced with AICyte (137 vs. 44 seconds). Diagnostic consensus among three pathologists using the AICyte system was strong, with a Kendall W coefficient of 0.802. The AICyte‐pathologist consensus reached an exact match with original interpretations in 95.1% of cases. AICyte‐assisted interpretations demonstrated improved specificity and diagnostic accuracy for glandular lesions compared with original interpretations while maintaining 100% sensitivity and negative predictive value. Conclusions To the authors' knowledge, this is the first study focusing on assessment of AGCs on an artificial intelligence system. The findings demonstrated that the AICyte system offers substantial improvements in efficiency and diagnostic consistency for the interpretation of AGCs and significantly reduces slide reading time. These results support the potential of AI to augment performance, especially in resource‐limited settings or high‐volume screening environments.
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.
The significant remaining challenge of screening for cervical glandular neoplasia
