Abstract
BackgroundAtypical glandular cells on cervical smears are often associated with clinically significant uterine lesions. The frequency and accuracy of AGC-NOS (i.e. atypical glandular cells, not otherwise specified) diagnoses, regardless of the gland cell type or the degree of suspicion, and their outcome were investigated.MethodsFrom January 1, 1990 to December 31, 1999 a total of 261 patients had an AGC-NOS diagnosis made by conventional cervical Papanicolaou smear interpretation representing 0.05% of all Pap-smears analyzed at the national level. 191 (73.2%) patients had a subsequent histological examination, 8 samples were not representative by origin and were excluded.ResultsOut of 183 AGC-NOS diagnosed, 56.3% (103/183) were associated with tissue-proven precancerous and/or cancerous lesions, 44% being of endocervical and 56% of endometrial origin. 75% of all AGC-patients were asymptomatic. 66.7% (6/9) of the patients with subsequent invasive endocervical adenocarcinoma (AC) and 56% (28/50) of those patients with invasive endometrial AC were without clinical symptoms. 3 patients out of 9 with an invasive endocervical AC were 35 years of age or less. 10.1% and 12.3% of all 'new' tissue-proven invasive endocervical or endometrial AC respectively recorded by the national Morphologic Tumour Registry (MTR) were first identified by a cytological AGC-NOS diagnosis.ConclusionOur findings emphasize the importance of the cytological AGC-category even in the absence of a precise origin or cell type specification. 56% of the AGC-diagnoses being associated with significant cancerous or precancerous conditions, a complete and careful evaluation is required.
Highlights
Atypical glandular cells on cervical smears are often associated with clinically significant uterine lesions
Classification modified by Soost in 1989 (Table 1) the current study focuses on the 'former' atypical glandular cells of undetermined significance (AGUS/TBS versus Class III G/MUNICH II) diagnosed during the 1990's in a non-academic laboratory [1,2,3,4,5,6,7]
From January 1, 1990 to December 31, 1999, a total of 566.809 cervico-vaginal smears were screened at the central division of clinical cytology of the National Health Laboratory (NHL) in Luxembourg (Western Europe)
Summary
Atypical glandular cells on cervical smears are often associated with clinically significant uterine lesions. The frequency and accuracy of AGC-NOS (i.e. atypical glandular cells, not otherwise specified) diagnoses, regardless of the gland cell type or the degree of suspicion, and their outcome were investigated. System" (TBS, 1989, 2001) for reporting cervico-vaginal. According to the 'original' definitions of "The Bethesda- cytological diagnoses and in analogy to the Munich II-. BMC Cancer 2004, 4:37 http://www.biomedcentral.com/1471-2407/4/37 Recommendation I Normal cells / II. Regenerative cells, immature metaplastic cells, important cytological control if necessary (with or without anti-inflammatory degenerative or inflammatory changes, para- and hyperkeratinizing or hormonal treatment) cells. Normal endometrial cells even after the menopause.
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