Clinical evaluation of atypical glandular cells of undetermined significance

Abstract

Objective: This study was undertaken to determine the clinical implications of the finding of atypical glandular cells of undetermined significance in cervical cytologic specimens in our patient population. Study Design: A retrospective study was performed. All cervical cytologic examinations with the diagnosis of atypical cells of undetermined significance between January 1992 and June 1997 were identified by means of a computerized database. Medical records were reviewed to identify patient demographic characteristics and to determine the presence or absence of associated pathologic conditions of the cervix and endometrium. The χ2 test and analysis of variance were applied to dichotomous and continuous variables, respectively, to determine the implications of a cytologic evaluation of atypical glandular cells of undetermined significance. Results: Cytologic results reported as atypical glandular cells of undetermined significance were obtained in a patient cohort of 492. Atypical glandular cells of undetermined significance was the only cytologic diagnosis in 224 patients; 268 patients had both atypical glandular cells of undetermined significance and an additional squamous abnormality, including atypical squamous cells of undetermined significance and cervical intraepithelial neoplasia I, II, or III. Two patients were excluded because of a history of endometrial cancer. A histologic evaluation was obtained within 1 year in 353 cases. Among the 353 patients who had a histologic evaluation performed, 227 (64%) had benign cervical and endometrial findings. There were 18 glandular lesions (5%), including complex hyperplasia with atypia, adenocarcinoma in situ of the cervix, adenocarcinoma of the cervix, and adenocarcinoma of the endometrium. A squamous lesion was present in 108 patients (31%). Most squamous lesions (81%) were found in patients with atypical glandular cells of undetermined significance associated with a squamous abnormality, whereas only 19% were found in patients with atypical glandular cells of undetermined significance as the only diagnosis. Women <35 years old had a much higher frequency of histologic abnormalities than did women >50 years old (P <.0001), with most of these lesions being squamous. Women >50 years old had a much higher frequency of glandular histologic abnormalities (P <.001). Conclusion: More than a third of women with Papanicolaou smears reported as showing atypical glandular cells of undetermined significance will be found to have a histologic abnormality. Women <35 years old with a cytologic evaluation of atypical glandular cells of undetermined significance have a higher frequency of histopathologic findings, with most being squamous lesions. Women with a cytologic evaluation of atypical glandular cells of undetermined significance who are >50 years old have more glandular lesions than do younger women. The term atypical glandular cells of undetermined significance is a misnomer. The significance of this cytologic finding has been defined and represents a marker for serious pathologic processes. (Am J Obstet Gynecol 2001;184:64-9.)