Clinical Significance of Atypical Glandular Cells in Cervical Papanicolaou Smears

Sanguan Lojindarat MD*, Jiraporn Luengmettakul MD*, Supalarp Puangsa-art MSc**

Affiliation : * Department of Obstetrics and Gynecology, Charoenkrung Pracharak Hospital, Bangkok, Thailand ** Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand

Objective : To determine the prevalence and the rate of clinically significant lesions in women with atypical glandular cells in cervical Papanicolaou smears. Material and Method: A retrospective study was performed from the cytologic database of Charoenkrung Pracharak Hospital. All cervical cytologic examinations with a diagnosis of atypical glandular cells (AGC) between January 2002 and December 2009 were identified. Medical records were reviewed to determine the clinical data. Cytologic and histologic follow-up was obtained to establish the presence of clinically significant lesions.
Results : One hundred eleven AGC Pap smears were identified from 47,347 Pap smears. The prevalence of AGC was 0.23% over the eight years of the period studied. Clinically significant lesions were diagnosed in 32.4% of the women, including invasive cancer in 18.3%. Women with AGC favor neoplasia were more likely to have clinically significant lesions (53.8%) than women with AGC not otherwise specified (20%, p = 0.003). The rate of clinically significant lesions in women aged 35 years or older (35.7%) was not statistically significant different from women younger than 35 years of age (20%, p = 0.356). All cases of invasive cancer were found in women aged 35 years or older. Cervical adenocarcinoma was the most common invasive cancer found in the present study.
Conclusion : Women with atypical glandular cells on Papanicolaou smears were correlated with significant risk for clinically significant lesions, including invasive cancer. Initial evaluation should include colposcopy, directed biopsy, and endocervical curettage. Women with risk factors for endometrial cancer should have an endometrial sampling.

Keywords : Atypical glandular cells, AGC, Papanicolaou smear, Bethesda System

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