Clinical significance of atypical glandular cells on Pap smears: Experience from a region with a high incidence of cervical cancer

Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Journal of Obstetrics and Gynaecology Research (Impact Factor: 0.93). 12/2010; 37(6):496-500. DOI: 10.1111/j.1447-0756.2010.01387.x
Source: PubMed

ABSTRACT To evaluate the histopathology of women who had atypical glandular cells (AGC) on Pap smears in a region with high incidence of cervical cancer.
This study was conducted at Chiang Mai University Hospital, Chiang Mai, Thailand. All women with AGC who underwent colposcopic and histopathologic evaluation between January 2002 and December 2008 were reviewed. Women with simultaneous diagnosis of squamous cell abnormality or prior history of cancer of any type were excluded.
Sixty-three women with AGC Pap test had histologic follow-up during the study period. Mean age was 44.9 years (range, 31-72 years). Six (9.5%) women were nulliparous. Sixteen (25.4%) women were postmenopausal. The histopathologic results of these 63 women were as follows: cervical intraepithelial neoplasia (CIN) 2-3, 5 (7.9%); adenocarcinoma in situ (AIS), 3 (4.8%); endometrial cancer, 3 (4.8%); cervical cancer, 2 (3.2%); endometrial hyperplasia (EH), 1 (1.6%); and no lesions, 49 (77.8%). The prevalence of significant lesions (CIN 2-3, AIS, EH, and cancer) in women with atypical glandular cells, favor neoplasia (AGC-FN) was significantly higher than that in the atypical glandular cells, not other specified (AGC-NOS) group (41.2% and 15.2%, P = 0.02).
Reporting AGC in our population is clinically significant due to the high prevalence of underlying preinvasive and invasive diseases (22.2%). This subtype of the AGC category is a significant predictor of such lesions.

  • [Show abstract] [Hide abstract]
    ABSTRACT: The 2001 Bethesda system recommends further classifying atypical glandular cells (AGCs) as either endocervical or endometrial origin. Numerous studies have investigated the clinical significance of AGC. In this study, we investigated the incidence of clinically significant lesions among women with liquid-based Papanicolaou cervicovaginal (Pap) interpretations of atypical endometrial cells (AEMs) or AGC favor endometrial origin (AGC-EM). More importantly, we correlated patients of AEM or AGC-EM with their clinical presentations to determine if AEM/AGC-EM combined with abnormal vaginal bleeding is associated with a higher incidence of significant endometrial pathology. All liquid-based Pap tests with an interpretation of AEM and AGC-EM from July, 2004 through June, 2009 were retrieved from the database. Women with an interpretation of atypical endocervical cells, AGC, favor endocervical origin or AGC, favor neoplastic were not included in the study. The most severe subsequent histologic diagnoses were recorded for each patient. During this 5-year period, we accessioned 332,470 Pap tests of which 169 (0.05%) were interpreted as either AEM or AGC-EM. Of the 169 patients, 133 had histologic follow-up within the health care system. The patients ranged in age from 21 to 71 years old (mean 49.7). On follow-up histology, 27 (20.3%) had neoplastic/preneoplastic uterine lesions. Among them, 20 patients were diagnosed with adenocarcinoma (18 endometrial, 1 endocervical, and 1 metastatic colorectal), 3 with atypical endometrial hyperplasia, and 4 with endometrial hyperplasia without atypia. All patients with significant endometrial pathology, except one, were over 40 years old, and 22 of 25 patients reported abnormal vaginal bleeding at the time of endometrial biopsy or curettage. This study represents a large series of women with liquid-based Pap test interpretations of AEM and AGC-EM with clinical follow-up. Significant preneoplastic or neoplastic endometrial lesions were identified in 20.3% of patients. Patients with Pap test interpretations of AEM or AGC-EM and the clinical presentation of abnormal vaginal bleeding should be followed closely.
    CytoJournal 01/2014; 11:29. DOI:10.4103/1742-6413.144686
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: At present, the "see and treat" approach for women with abnormal cervical cytology is widely accepted. It has been proven to be more cost-effectiveness than conventional management, making it particularly attractive for many regions in Thailand where resources are limited and poor patients' compliance is expected. However, the main disadvantage of the "see and treat" approach is the risk of overtreatment. National Health Service (NHS) guidelines recommend that the overtreatment rate in the "see and treat" approach must be less than 10%. The overtreatment rate appears to be acceptable if the "see and treat" approach is carried out in women with high-grade squamous intraepithelial lesion (HSIL) cytology or in women with lesser grades of smear abnormality whose colposcopic findings suggest high-grade disease.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cervical cytology remains the principal screening method to detect pre-invasive and invasive cervical lesions. Management of abnormal cervical cytology depends on the risk of encountering a significant cervical lesion or high-grade cervical disease. These risks may vary in different areas across the country. Thus, determining the rate of significant cervical lesion associated with each type of abnormal cervical cytology in each area is of critical importance for designing area-specific management approach. This review was conducted to evaluate the rate of high-grade cervical disease among Thai women with abnormal cervical cytology. A relatively high incidence of underlying significant lesions including invasive disease was demonstrated even in those having only minimal smear abnormality. This baseline information is crucial and must be taken into consideration in management of women with abnormal cytological screening to achieve the goals of comprehensive cervical cancer control in Thailand.
    Asian Pacific journal of cancer prevention: APJCP 08/2014; 15(16):6489-94. DOI:10.7314/APJCP.2014.15.16.6489 · 1.50 Impact Factor