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


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.

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    • "All 13 patients with endometrial lesions had endometrial cancer, with the youngest being 41 years of age. While a review of the literature shows that 75%–88% of uterine body lesions in AGC are endometrial cancer (9,17), all lesions detected in our study were endometrial cancer. Moreover, Haidopoulos et al. "
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    ABSTRACT: Forty-one patients diagnosed with atypical glangular cells (AGC) underwent surgery, and the histopathological diagnosis results for the resected specimens and the clinical features were analyzed. Out of 41 patients, final pathological diagnosis was endometrial cancer in 13 patients, cervical adenocarcinoma in 8, AIS in 7, CIN3 in 6, others in 2, and no lesions in 5. In comparison with previous reports, malignant or premalignant lesions were detected more frequently in patients with AGC who underwent surgery. We believe that conization or hysterectomy aimed at diagnosis and treatment, as well as endometrial histodiagnosis, should be carried out aggressively in patients with AGC.
    Full-text · Article · Feb 2014 · Cancer Investigation
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    • "The present study showed that 5.7% of AGC women did not receive appropriate investigations; this finding is consistent with others indicating that this is a frequent occurrence [4]. "
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    ABSTRACT: To determine incidence, originating organ, and factors predicting significant histopathology (premalignant and malignant lesions) among women with atypical glandular cells (AGCs) on liquid-based cytology (LBC). In a retrospective study at Siriraj Hospital, Bangkok, Thailand, clinical and histologic data were reviewed for women with AGCs who underwent appropriate examinations from January 2007 to December 2010. There were 284 women with AGC cytology (mean age, 51.2years). The incidence of significant pathology and invasive cancer was 43.3% and 34.5%, respectively. The most common malignant organ was the uterus (64/123, 52%). Predictors of serious pathology were AGC favor neoplasia (AGC-FN) endocervical (odds ratio [OR], 5.64; 95% confidence interval [CI], 1.62-19.57), AGC-FN endometrial (OR, 4.11; 95% CI, 1.27-13.32), AGC-FN glandular (OR, 8.23; 95% CI, 2.02-33.49) subtypes, and bleeding (OR, 2.88; 95% CI, 1.47-5.65). Combining patient age and AGC subtype, there were no serious cervical lesions among women aged 50years or younger with AGC-FN glandular subtype, or serious non-cervical neoplasia among women aged 50years or younger with AGC not otherwise specified (AGC-NOS) or AGC-FN endocervical subtypes. AGC subcategories defined from LBC, alone or combined with patient age, might be predictors of significant histopathology, cancer incidence, and originating organ.
    Full-text · Article · Jul 2012 · International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
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    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.
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