Abstract
Introduction: Atypical glandular cells (AGC) are carriers of insufficient nuclear abnormalities for the diagnosis of adenocarcinoma, but exceed the criteria for classification as reactive glandular cells. This is an uncommon diagnosis, which may be associated with neoplastic lesions. Objective: To evaluate the clinical significance of primary cytological diagnosis of AGC through correlation with results of subsequent cyto-histologic examination. Materials and methods: 10 years retrospective study based on cervical cytologic results indicating AGC, classified as possibly non-neoplastic or cannot exclude high-grade intraepithelial lesion. It was performed cyto-histopathological correlation in cases that were submitted to subsequent histopathological examination up to two years after cervical cytology analysis. Results: AGC were reported in 380 (0.06%) exams, providing 160 cases with subsequent biopsy. 85 (53.1%) of these, presented benign changes and 75 (46.9%) neoplastic lesions. From 114 possibly non-neoplastic cytological results, 71 (62.3%) had benign histological changes, and 43 (37.7%) neoplastic lesions, corresponding to a negative predictive value (NPV) of 62.3%. In contrast, among the 46 AGC cannot exclude high-grade intraepithelial lesion results, 14 (30.4%) presented benign changes and 32 (69.6%) neoplastic lesions (positive predictive value [PPV] = 69.6%). Discussion: The high rate of cancer associated with the diagnosis of AGC reassures the importance of recognizing these atypical cells in pap smears. The classification of possibly non-neoplastic and cannot exclude high-grade intraepithelial lesion may suggest the origin of cytological changes. Conclusion: Our results reinforce the importance of adequate follow-up of patients with AGC diagnosis on cervical cytology.
Highlights
Atypical glandular cells (AGC) are carriers of insufficient nuclear abnormalities for the diagnosis of adenocarcinoma, but exceed the criteria for classification as reactive glandular cells
In 2001, the term AGUS was abandoned, and was replaced by “atypical glandular cells” (AGC) to avoid similarity with the acronym ASCUS (“atypical squamous cells of undetermined significance”)(7, 14). These glandular atypia are defined as cells with insufficient nuclear changes for diagnosis of adenocarcinoma, but that exceeds the criteria for classification as reactive glandular cells or reparative process[2, 11]
It is an uncommon diagnosis, reported ten times less than the atypical squamous cells in cytological examinations[2]. The incidence of this cytological change may vary from one diagnostic servicetoanother,theirvaluesrangesfrom0.1to2.1%(9, . 15,17) InBrazil, according to the Ministry of Health data for 2009, it was diagnosed 0.13% AGC among all satisfactory examinations performed, and 4.6% considering only the abnormal results[10]
Summary
Atypical glandular cells (AGC) are carriers of insufficient nuclear abnormalities for the diagnosis of adenocarcinoma, but exceed the criteria for classification as reactive glandular cells This is an uncommon diagnosis, which may be associated with neoplastic lesions. Materials and methods: 10 years retrospective study based on cervical cytologic results indicating AGC, classified as “possibly non-neoplastic” or “cannot exclude high-grade intraepithelial lesion” It was performed cyto-histopathological correlation in cases that were submitted to subsequent histopathological examination up to two years after cervical cytology analysis. In 2001, the term AGUS was abandoned, and was replaced by “atypical glandular cells” (AGC) to avoid similarity with the acronym ASCUS (“atypical squamous cells of undetermined significance”)(7, 14) These glandular atypia are defined as cells with insufficient nuclear changes for diagnosis of adenocarcinoma, but that exceeds the criteria for classification as reactive glandular cells or reparative process[2, 11]. We know that AGC diagnosis tends to be more frequent in patients older than 40 years of age, representing up to 71.4% of cases[11]
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