Clinical implications and histological correlation of atypical glandular cells found in cervicovaginal smears

Abstract

Introduction: Atypical glandular cells (AGC) are carriers of insufficient nuclear abnormalities for the diagnosis of adenocarcinoma, but exceed the criteria for classification as reactive glandular cells. This is an uncommon diagnosis, which may be associated with neoplastic lesions. Objective: To evaluate the clinical significance of primary cytological diagnosis of AGC through correlation with results of subsequent cyto-histologic examination. Materials and methods: 10 years retrospective study based on cervical cytologic results indicating AGC, classified as "possibly non-neoplastic" or "cannot exclude high-grade intraepithelial lesion". It was performed cyto-histopathological correlation in cases that were submitted to subsequent histopathological examination up to two years after cervical cytology analysis. Results: AGC were reported in 380 (0.06%) exams, providing 160 cases with subsequent biopsy. 85 (53.1%) of these, presented benign changes and 75 (46.9%) neoplastic lesions. From 114 "possibly non-neoplastic" cytological results, 71 (62.3%) had benign histological changes, and 43 (37.7%) neoplastic lesions, corresponding to a negative predictive value (NPV) of 62.3%. In contrast, among the 46 AGC "cannot exclude high-grade intraepithelial lesion" results, 14 (30.4%) presented benign changes and 32 (69.6%) neoplastic lesions (positive predictive value [PPV] = 69.6%). Discussion: The high rate of cancer associated with the diagnosis of AGC reassures the importance of recognizing these atypical cells in pap smears. The classification of "possibly non-neoplastic" and "cannot exclude high-grade intraepithelial lesion" may suggest the origin of cytological changes. Conclusion: Our results reinforce the importance of adequate follow-up of patients with AGC diagnosis on cervical cytology.

Atypical glandular cells: Help or hindrance

“…9 Evidences from previous studies evaluating histological results in women with a diagnosis of AGC have shown that it includes a range of benign changes as well as cervical precursor lesions of glandular and/or squamous origins to invasive cervical cancer and other gynaecological cancers. 10 In the present study ,the prevalence of diagnostic category of AGC was 0.05% which is comparable with study by Loos et al 11 ,quoting 0.06 % prevalence of AGC among cervical smears. In our study 53% of cases were benign diagnoses on subsequent biopsy and 47% had malignancy.…”

“…13 Similarly Loos et al revealed 46.9% malignant lesions on histological follow up of AGC diagnosis. 11 In the present study histopathological correlation revealed 39 out of the 66 malignant cases(in situ and invasive) to be of glandular origin (59%) while the remaining 27 (40%) cases to be of squamous origin . The proportion of adenocarcinoma is higher as compared to previous studies which quote higher percentage of invasive squamous cell carcinoma diagnosed through a histopathological analysis in patients with AGC as mentioned in six articles, [15][16][17][18][19][20] of which five were published from 2003 to 2009.…”