Cytologic and histologic review of atypical glandular cells (AGC) detected during cervical cytology screening

Abstract

This article is to determine the clinical significance and underlying pathology among patients with atypical glandular cells (AGC) identified during cervical Papanicolau (Pap) smear screening. AGC slides were searched from 51,412 computerized files of the cytology laboratory of Mackay Memorial Hospital during a 29-month period. The results of clinical evaluations were reviewed and an experienced gynecologic cytopathologist who was not involved in the original cytologic diagnosis and was not aware of the clinical results of the follow-up examinations rechecked all AGC slides. We used the z score to determine whether different results were achieved after the gynecologic cytopathologist rechecked the slides. We further analyzed all slides with different cytologic diagnoses and compared results with the histologic diagnoses. Forty-nine cases were initially identified as AGC. Among these, 29 were reviewed and identified as AGC again, and the result of biopsies revealed that they were all chronic cervicitis, ie, negative for malignancy or premalignancy. The other 20 cases were reviewed and diagnosed as non-AGC. Among the results of cytologic examinations, seven had inflammation, two had atypical squamous cells of undetermined significance (ASC-US), ten had high-grade cervical intraepithelial neoplasia (CIN), and one had adenocarcinoma. The results of histologic diagnosis included eight cases with normal tissue, two with CIN grade 1, eight with high-grade CIN, one with microinvasive squamous cell carcinoma, and one with adenocarcinoma. Histologic results revealed 20.4%1 (10/49) and 50% 1(10/20) at initial cytologic diagnosis of AGC and expert-reviewed non-AGC, respectively, which were finally at least high-grade CIN. According to the gynecologic cytopathologist's diagnosis, 59.2%1 (29/49) of cases would have eliminated unnecessary histologically diagnostic procedures. In conclusion, clinicians should be careful about the significance of the cytologic diagnosis of AGC, because there may actually be an underlying pathology, which can be identified by a pathologist who is an expert in gynecologic cytopathology. The interobserver variation in diagnosing AGC favors specialized training in gynecologic cytopathology. In addition, prompt diagnostic interventions, including colposcopy, endocervical curettage, and/or endometrial biopsy, should be performed after confirmation of the diagnosis of non-AGC by an experienced gynecologic cytopathologist.

Comparative sensitivities of ThinPrep and Papanicolaou smear for adenocarcinoma in situ (AIS) and combined AIS/high-grade squamous intraepithelial lesion (HSIL): Comparison with HSIL

“…[17][18][19] Other studies focus on the detection of atypical glandular cells of undetermined significance, [20][21][22][23][24] an imprecise term, which is recognized to yield more high-grade squamous lesions than high-grade endocervical glandular lesions. 22,[25][26][27] The concurrent presence of cells from an HSIL did not increase the sensitivity of cervical cytology; in fact, cytologists were less likely specifically to recognize a high-grade glandular lesion. This finding was true for both the PS group and the TP group.…”

The Significance of Glandular Cells on Conventional Cervicovaginal Smears: Experience from a Tertiary Care Hospital in Coastal India

“…3 a, b). Similarly, another case was reported as invasive SCC on cytology, which showed [8] 21,854 83 0.4 Gutman et al [9] 11,800 45 0.38 Crasta et al [10] 10,787 19 0.17 Adhya et al [11] 18,376 65 0.35 Ajit et al [12] 22,618 74 0.32 Jeng et al [13] 51,419 49 0.09 Scheiden et al [14] 522 adenosquamous carcinoma on histopathology. This was due to the presence of only malignant squamous cells on cytology ( Fig.…”

“…AGC interpretation is known to have interobserver variation and necessitates specialized training in gynecologic cytopathology. In addition, prompt diagnostic interventions, including colposcopy, endocervical curettage, and/or endometrial biopsy, should be performed after confirmation of the diagnosis of AGC by an experienced gynecologic cytopathologist [13] .…”

A cytohistologic study of atypical glandular cells detected in cervical smears during cervical screening tests in Iran

“…The rates of AGC (reported as AGUS before 2001) quoted in the literature vary from 0.095% to 1.83%, as shown in Table 4 (5,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) . An AGC rate of 0.81% in our study is consistent with most related reports in the literature.…”