Clinicopathological Characteristics of Atypical Glandular Cells Determined by Cervical Cytology in Japan: Survey of Gynecologic Oncology Data from the Obstetrical Gynecological Society of Kinki District, Japan

Abstract

Background: The purpose of this study was to clarify the clinicopathological characteristics of, and the clinical approach used to identify, atypical glandular cells (AGCs) in Japan based on cervical cytology screening. Objectives: This study included 1,254 patients with AGCs who underwent cervical cytology. Method: Data from patients with AGCs were used to examine the practical management of AGCs and the histological results. Results: The incidence of AGCs was 0.20% (1,254/614,791). The 1,254 AGC cases included 859 endocervical cells not otherwise specified (NOS), 3 glandular cells NOS, 91 endocervical cells favor neoplasia (FN), and 301 atypical endometrial cells (AEMCs). Among the 1,254 AGC patients, the histological diagnosis was benign in 666 (53.1%), cervical intraepithelial neoplasia (CIN) 1 in 60 (4.8%), CIN2 in 31 (2.5%), CIN3 in 52 (4.1%), squamous cell carcinoma in 19 (1.5%), adenocarcinoma in situ in 39 (3.1%), cervical adenocarcinoma in 106 (8.5%), endometrial carcinoma in 209 (16.7%), ovarian cancer in 26 (2.1%), other malignancy in 4 (0.3%), and other under follow-up in 42 (3.3%). When the 1,254 AGC patients were divided into three medical intervention degrees according to histology, AGC-NOS, AGC-FN, and AEMC required no medical intervention in 78.7, 13.2, and 25.9% (678, 12, and 78) of the patients, cervical cone resection in 13.0, 9.9, and 0.3% (112, 9, and 1) of the patients, and radical laparotomy for invasive cancer in 8.3, 76.9, and 73.8% (72, 70, and 222) of the patients, respectively. Conclusions: Our histological results supported the medical interventions applied for AGC diagnosis and treatment. AGC cases require careful histological evaluation.

Atypical glandular cells in Papanicolaou test: Which is more important in the detection of malignancy, architectural or nuclear features?

“…Suresh et al reported a 66.7% malignancy rate, while Selvaggi and Kirwan reported malignancy rates of 78% and 81.6%, respectively, but similar with other studies, our study showed that endometrial cancer was the most common cancer 21‐23 . The most common primary sites for metastatic tumours in AGC cases have been reported to be the colon and breast in the literature 8,12,13,20 …”

“…The largest sample of AGC in the literature was the study of Toyoda et al In their study, published in 2019 and including 1254 AGC cases, they found 182 (14.5%) premalignant lesions and 364 (29.1%) invasive carcinomas. Among the invasive carcinomas, endometrial carcinomas were found at a rate of 57.4%, followed by cervical adenocarcinoma (29.1%), ovarian carcinoma (7.1%), and squamous cell carcinoma (5.2%), and 4 cases had metastasis (1.1%) 20 . Some studies also reported higher malignancy rates than expected in AGC cases.…”

An audit of liquid‐based cytology samples reported as high‐risk human papillomavirus and borderline nuclear change in endocervical cells

“…If investigations are normal, the current policy of returning these women to routine recall or offering cytological follow‐up in 12 months, rather than 6, appears risky in view of the high rates of significant lesions in women with glandular cytology, HR HPV and negative colposcopy . As reported in this paper, the accuracy of colposcopy is moderate and it is possible that the punch biopsy may not be representative of the area of pathology.…”

Cervical cytology profile by Papanicolaou smear in a rural setting in mid-Kerala

“…Our finding of 1.4% is more than 0.2% AGC found in a large study done in Japan and reported in 2019. 18 The incidence of AGC in a 10 year analysis of conventional Pap smears in Luxembourg was 0.05%. 19 Out of 39,484 Pap smears, the percentage of AGUS cells was 1.2% in a study published in 1998, which is fairly similar to our study.…”