Clinical Significance of Atypical Glandular Cells on Cervical Cytology

Schnatz, Peter F.; Guile, Matthew W.; O’Sullivan, David; Sorosky, Joel I.

doi:10.1097/01.aog.0000202401.29145.68

Cited by 148 publications

(147 citation statements)

References 34 publications

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“…9 Several studies have demonstrated that AEC may be associated with premalignant or malignant cervical lesions but most have been limited by short follow-up periods and/or relatively small numbers of cases. 7,[10][11][12] Furthermore, the risk of significant pathology has not always been correlated with age, prior smear history, presence of endocervical cells in preceding cytology samples or the socio-economic status of the patient. In the present study, we have investigated the potential relationship between these factors and the risk of high-grade cervical dysplasia and gynaecological malignancies in women with a cytological diagnosis of AEC in Western Australia (WA) over a seven-year period.…”

Section: Introductionmentioning

confidence: 99%

Risk of high‐grade cervical dysplasia and gynaecological malignancies following the cytologic diagnosis of atypical endocervical cells of undetermined significance: A retrospective study of a state‐wide screening population in Western Australia

Munro¹,

Williams

Semmens

et al. 2015

Aust NZ J Obst Gynaeco

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Background: In 2006, Australia adopted a revised cervical cytology terminology system, known as the Australian Modified Bethesda System (AMBS). One substantial change in the AMBS was the introduction of the diagnostic category of atypical endocervical cells (AEC) of undetermined significance. Aim: The aim of this study was to investigate the incidence of histologically confirmed high-grade cervical dysplasia (cervical intra-epithelial neoplasia (CIN) grades 2 and 3 and adenocarcinoma in situ (ACIS)), cervical carcinoma and endometrial carcinoma in women presenting with AEC on cervical cytology. Methods: A seven-year retrospective study examining clinical outcomes of women with AEC on a screening cervical smear. Cytology and histology results were extracted from the Western Australia Cervical Screening Registry, and time-toevent analysis was used to predict the odds of having or developing in situ and invasive neoplasia. Results: AEC was reported in index smears from 0.093% (584/622754) women during the study period. No follow-up was available in 35 AEC cases. Sixty-five of the remaining 549 women (11.8%) had, or developed, high-grade cervical dysplasia within five years of their index AEC diagnosis. Endometrial cancer was diagnosed in 21 women and cervical cancer in four women during the follow-up period. Conclusion: Cytologic demonstration of AEC requires careful gynaecologic evaluation, particularly in younger women who may be found to have either high-grade squamous (CIN) or glandular (ACIS) lesions, while in older women, the possibility of endometrial neoplasia needs to be considered.

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Section: Introductionmentioning

confidence: 99%

Risk of high‐grade cervical dysplasia and gynaecological malignancies following the cytologic diagnosis of atypical endocervical cells of undetermined significance: A retrospective study of a state‐wide screening population in Western Australia

Munro¹,

Williams

Semmens

et al. 2015

Aust NZ J Obst Gynaeco

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“…Among benign or reactive changes are included endocervical and endometrial polyps, tubal metaplasia, cervical endometriosis, microglandular hyperplasia, genital tract inflammatory changes, and direct sampling of the lower uterine segment cells. On the other hand, it may also represent/correspond to squamous and glandular cervical lesions (malignant and pre-malignant), endometrial hyperplasia, invasive endometrial adenocarcinoma, and extra-uterine tumor (tubal, ovarian, and bowel), among others (2,3,11,12) . ACG are divided in two groups, according to their estimated significance: "possibly non-neoplastic" or "cannot exclude highgrade intraepithelial lesion", as the Nomenclatura Brasileira para Laudos de Colpocitologia (Brazilian Nomenclature for Cervical Cytology Reporting).…”

Section: Introductionmentioning

confidence: 99%

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

Loos¹,

Coelho²,

França³

et al. 2014

Jornal Brasileiro De Patologia E Medicina Laboratorial

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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.

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“…Although our HPV-DNA testing sample was small in size we found a ratio of HPV associated cervical disease of 50% which indicates that the concomitant use of HPV-DNA can be very useful on AGC followup when no significant pathology is found on cervix or endometrium since studies report a false negative rate of 4.7% in AGC follow-up [6].…”

Section: Discussionmentioning

confidence: 71%

“…Whereas these used to account for less than 5% of all cervical cancers, they now comprise 20% to 25% [4]. One of the main reasons for the increasing relative rate of adenocarcinomas seems to be the lower Pap sensitivity in diagnosing glandular lesions and a high false negative rate [5,6]. Glandular abnormalities are found in 0.1 to 2.1% of Pap tests being more frequent in women over 40 [7,8].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Implication of a Typical Glandular Cells; a Five Years Experience of a Single Institution in Portugal

Ribeiro¹,

Correia²,

Aguilar³

et al. 2015

Gynecol Obstet (Sunnyvale)

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Clinical Significance of Atypical Glandular Cells on Cervical Cytology

Cited by 148 publications

References 34 publications

Risk of high‐grade cervical dysplasia and gynaecological malignancies following the cytologic diagnosis of atypical endocervical cells of undetermined significance: A retrospective study of a state‐wide screening population in Western Australia

Risk of high‐grade cervical dysplasia and gynaecological malignancies following the cytologic diagnosis of atypical endocervical cells of undetermined significance: A retrospective study of a state‐wide screening population in Western Australia

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

Clinical Implication of a Typical Glandular Cells; a Five Years Experience of a Single Institution in Portugal

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