Histological follow-up in patients with atypical glandular cells on Pap smears

Abstract

Context:Atypical glandular cells (AGCs) result in the Papanicolaou (Pap) smear may be associated with significant genital and nongenital neoplastic processes.Aims:To evaluate the underlying histopathology in women who had AGCs on Pap smears.Settings and Design:Retrospective cross-sectional study.Patients and Methods:Clinicopathological data of patients who had AGC on Pap smears and underwent histological workup between January 2004 and December 2014 were retrieved from the computerized database of a tertiary care center. Patients with a prior history of cervical intraepithelial neoplasia or gynecological cancer were excluded.Statistical Analysis Used:Chi-square test or Fisher's exact tests were used as appropriate.Results:Cytological examination of the uterine cervix was carried out in 117,560 patients. We identified 107 patients (0.09%) with AGC and 80 of those with histological follow-up were included in the study. The median age at diagnosis was 47 years (range, 18–79), and 32 women (40%) were postmenopausal, while 56 (70%) had gynecological symptoms. Significant preinvasive or invasive lesions on pathological examination were detected in 27 (33.8%) patients, including 12 endometrial adenocarcinomas (15%), 8 cervical carcinomas (10%), 3 cervical intraepithelial neoplasia II/III (3.75%), 2 ovarian adenocarcinomas (2.5%), and 2 metastatic tumors (2.5%). Univariate analysis showed that postmenopausal status (P < 0.001), age >50 years old (P < 0.001), having symptoms at the time of admission (P = 0.041), and AGC “favor neoplasia” smear results (P = 0.041) were the clinical factors associated with significant pathological outcome.Conclusions:Patients with AGC on Pap smears should be evaluated vigilantly with histological workup, especially if they are postmenopausal or symptomatic.

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

“…Although several studies have investigated the incidence, cytopathological findings, and malignancy ratio of AGC, the results vary significantly. The incidence of AGC ranges from 0.08% to 2.1% in the literature 3‐9 . Similar to what is reported in the literature, the incidence rate of AGC was 0.22% in our study.…”

“…In the literature, clinically significant pathologies were reported to range widely from 15% to 59% of women with AGC Pap results 4,5,7‐15 . The malignancy rate in AGC‐FN cases was higher than that in AGC‐NOS cases 8,10,16,17 .…”

“…Similar with the study of Daniel et al, many publications in the literature have shown the relationship between patient age and lesion location in the AGC group. In these studies, clinically significant squamous lesions were observed in women aged <40 years, while glandular lesions were more common in women aged >40 years, and the most common glandular lesion is endometrial carcinoma 4,9,11,12,14,16‐19 . Therefore, all of the studies mentioned the importance of biopsy‐based endometrial evaluation especially in postmenopausal women.…”

Glandular Cell Abnormalities on SurePath Preparations: A Retrospective Review with Cytology-Histology Correlations

“…A comprehensive recent work reviewed multiple aspects on the detection of uterine glandular lesions by SurePath in a Bethesda reporting environment [21], while other available SurePath cytology-histology correlation studies offer important considerations. However, they focus on a specified aspect of performance (detection rate in endometrial carcinomas [22]), use a mixed ThinPrep-SurePath pool of cases without comparison between the two technologies [23], or report cytology findings in a non-Bethesda reporting environment, making the findings less applicable to laboratories adhering to Bethesda guidelines [24-26]. …”

LBC versus Conventional Pap Smear in AGUS; Do we do any better with Liquid-Based Preparations?

“…Other studies have found that subcategorization of AGUS may give a higher yield of significant lesions in specific subgroups [11,[13][14][15] We can assume that the risk of an underlying malignant or premalignant lesion is of the same magnitude in Norway, and our current practice of follow up is justified and in compliance with international studies [10,13,15].…”