Atlas of Gynecologic Cytology

 This concise atlas evaluates the use of digital imaging technology, with emphasis on TelePAPology™, for the pathological examination of gynaecological problems, specifically the PAP smear.

TelePAPology™ is a web-based diagnostic process allowing virtual slides to be analysed and interpreted remotely.

Beginning with the historical background of the Pap test, the following chapter examines its future and the impact of digitisation and automation. The atlas then provides in depth discussion on TelePAPology™, and other gynaecological abnormalities.

Authored by internationally recognised experts from The University of Kansas School of Medicine, this illustrative atlas includes numerous images accompanied by descriptions of cytologic and histologic criteria for the corresponding pathologic entities, and explanatory notes.

 

Key points

• Concise atlas evaluating use of digital imaging technology for pathological examination of gynaecological problems
• In depth coverage of TelePAPology™
• Authored by experts from University of Kansas School of Medicine
• Includes numerous cytologic and histologic images with descriptions

1. The State of the Pap Test: A Historical Perspective, 

 from Past to Present 1

 Ossama Tawfik, Marilyn Davis

2. The Future of the Pap Test: Digitization and Cytology 6

 Ossama Tawfik

• Digital Cytopathology and Telecytology 6

 – Advantages of Telepathology 7

3. The TelePAPologyTM Solution 10

 Ossama Tawfik, Marilyn Davis

• What is TelePAPologyTM? 10

 – Methodology 10

• Motivation for TelePAPologyTM 12

 – Advantages of TelePAPologyTM 13

4. TelePAPologyTM and the Bethesda Reporting System 17

 Ossama Tawfik

• Normal Anatomy and Histology 17

• The Bethesda Reporting System 18

• TelePAPologyTM and the Bethesda Reporting System 19

5. Specimen Adequacy, Infections and Other Benign Changes 20

 Ossama Tawfik

• Specimen Adequacy 20

• Squamous Cells 21

• Glandular Cells 22

• Benign Cellular Changes 34

 – Squamous Metaplasia 34

• Keratosis 37

• Reparative/Regenerative and Inflammatory Changes 37

• Organisms and Infections 52

 – Shift in Flora Suggestive of Bacterial Vaginosis (BV) 52

 – Fungal Organisms Morphologically Consistent with Candida Species 55

 – Trichomonas Vaginalis 58

 – Herpes Simplex 58

– Cytomegalovirus (CMV) 61

CONTENTSxii ♦ Atlas of Gynecologic Cytology

6. Epithelial Abnormalities: Squamous Cells 62

 Marilee Means

• Squamous Cell Lesions of the Uterine Cervix 62

– Atypical Squamous Cells of Undetermined Significance (ASCUS) 62

– Low Grade Squamous Intraepithelial Lesion (LSIL) 67

 – High Grade Squamous Intraepithelial Lesion (HSIL) 74

• Squamous Cell Carcinoma 81

 – Keratinizing Type 84

– Non-keratinizing Type 86

7. Epithelial Abnormalities: Glandular 88

 Ossama Tawfik

• Glandular lesions of the Uterine Cervix 88

• Atypical Glandular Cells of Undetermined Significance (AGUS) 89

• Endocervical Adenocarcinoma In Situ 103

• Invasive Endocervical Adenocarcinoma 105

• Endometrial Adenocarcinoma 108

• Rare Lesions and Metastatic Tumors to the Uterus 111

8. Ancillary Testing and Image Analysis 117

 Ossama Tawfik, Brian Potetz

• Human Papillomavirus Testing 117

• Diagnostic Utility of TelePAPologyTM and 

 Immunohistochemistry 118

– p16, MIB-1 and ProExTM C Immunohistochemistry   118

• Evaluation of Atypical Glandular Cells 128

 – Evaluation of Adenocarcinomas (Endocervical vs 

 Endometrial vs Metastatic) and Other Malignancies 128

• Utilization of Cellblocks Provides an Added Value of 

 Performing Additional Ancillary Tests for Infectious Diseases 128

• Image Analysis 131

 – The Value of Computer-Aided Image-Based Scoring Algorithms 

Suitable for a Remote, Web-Based (GPS Guided) Analysis of 

Cellblock Preparations from Pap Samples 131

 – Performance 132

 – Software 134

 – Feature Extraction 134

– Learning and Classification 136