Atypical endocervical glandular cells: Accuracy of cytologic diagnosis

Abstract

Atypical cells thought to be of endocervical glandular origin often cause diagnostic uncertainty in cervicovaginal smears. For this reason consecutive cases of endocervical glandular atypia diagnosed in smears were correlated with subsequent biopsy diagnoses and then retrospectively reviewed. Smears were originally diagnosed as "mild glandular atypia, probably reactive" or "severe glandular atypia, suggestive of adenocarcinoma in situ" (AIS). Biopsy follow-up was obtained on 34 of 58 patients diagnosed with severe endocervical glandular atypia. Nine patients (26%) had AIS, three with concomitant high-grade squamous intraepithelial lesions (HSIL) and tow with invasive adenocarcinoma. Eighteen patients (53%) had HSIL only. Seven had benign changes. Of 152 patients diagnosed with mild glandular atypia, biopsy follow-up was obtained on 40. One patient had AIS; 14 (35%) had HSIL; one had low-grade SIL (LSIL); and 24 (60%) had benign changes. Blinded review of these smears yielded results similar to those in the biopsy follow-up, that is, the prediction of AIS on smears included most cases of AIS, some invasive adenocarcinomas, a significant number of HSIL, cases and a few benign lesions. A review diagnosis of "reactive glandular cells" proved to be HSIL in 31% of cases and AIS in one case. We conclude that patients with a diagnosis of severe glandular atypia in smears may prove to have AIS or invasive adenocarcinoma, but often have HSIL without concomitant AIS. In addition, although "reactive" glandular atypia in smears usually reflects a benign condition, a significant minority of such patients prove to have HSIL.

Atypical glandular cells of undetermined significance in conventional cervical/vaginal smears and thin-layer preparations

“…The PPVs for the endocervical AGUS subcategories demonstrated a marked difference between the "favor neoplasia" designation and either the "unspecified" or "favor reactive" designations in both types of preparations (67% vs. 28% vs. 10% in TPs and 77% vs. 23% vs.4% in CPs). These differences are similar to those reported in other studies of biopsy follow-up results after an AGUS interpretation in CPs, [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] and in one similar study using TPs, 20 and demonstrate that differences in PPVs among endocervical AGUS subcategories are similar in both TPs and CPs. Although the number of cases was small, we found that the AGUS "endometrial" category had a very low PPV in both groups.…”

“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] In general, those laboratories that report lower AGUS frequencies have higher PPVs for the detection of a high-grade precursor lesion or carcinoma and for lesions found to have glandular rather than squamous differentiation on follow-up. 6,9,16 In contrast, laboratories with higher AGUS frequencies have shown a high preponderance of either benign processes or high-grade CIN on biopsy follow-up.…”

“…AGUS has been a problematic interpretation clinically because biopsy follow-up mostly has shown either a benign reactive process or a squamous precursor lesion (cervical intraepithelial neoplasia [CIN]) rather than a glandular one. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] The ThinPrep Papanicolaou test (TP) (Cytyc Corporation, Boxborough, MA) is a slide preparation method that utilizes liquid fixa-tion of the exfoliated cells. It has been shown to produce well preserved thin-layer slides devoid of the artifacts that may contribute to inaccuracies in the interpretation of conventional smears.…”

Clinical implications of atypical glandular cells of undetermined significance, favor endometrial origin

“…Most laboratories report an AGUS rate Ͻ 1%. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] The AGUS rate of 0.56% observed among the general patient population in our laboratory was in agreement with the current literature. Few studies have investigated the incidence of atypical endometrial cells in cervicovaginal smears.…”

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Little is known about the clinical significance of AGUS, favor endometrial origin (AGUS-EM). In this retrospective study, we determined the rate of a diagnosis of AGUS-EM and the incidence of clinically significant lesions in women with this cytologic diagnosis on subsequent follow-up.…”