Histologic Implications of Pap Smears Classified as Atypical Glandular Cells

Abstract

This study was conducted to investigate the correlation between cytologic findings and histologic diagnoses in cervical smears classified as atypical glandular cells (AGC). A review of the medical records from 41,400 Pap smears performed during the 2-year period from January 2000 to January 2002 identified 113 (0.27%) women with a diagnosis of AGC. All smears were reclassified to conform to the 2001 Bethesda System categories, which are: AGC not otherwise specified (AGC NOS), AGC favor neoplasia, and endocervical adenocarcinoma-in situ. All patients were evaluated with colposcopy and endocervical curettage. Women over age 35 years also underwent endometrial biopsy. Ectocervical biopsies were taken in patients whose Pap smears also contained abnormal squamous cells. In patients whose smears were diagnosed as cervical adenocarcinoma-in situ, a cone biopsy was done. Study subjects were an average age of 52 years. Two thirds (77 of 113; 68%) of patients were 45 years or more. Sixty-four (57%) had a diagnosis of ACG NOS. There were 48 women with a diagnosis of AGC favor neoplasia (43%) and a single patient was diagnosed with adenocarcinoma-in situ. In 27 patients (24%), a squamous abnormality, including ASCUS or cervical intraepithelial neoplasia (CIN), was also diagnosed on the cervical smear. Endometrial disease was diagnosed in 14 women, including 9 (8%) with endometrial adenocarcinoma and 5 (4.4%) with endometrial hyperplasia. Of 16 patients with significant squamous cell abnormalities, 13 were found to have CIN, whereas only 3 had invasive squamous cell carcinoma of the cervix. The mean age of women with squamous abnormalities was 42 years, significantly lower than the mean age of 58 in women with endometrial lesions (P = .009). When a diagnosis of AGC NOS was made, only 10.9% (7 of 64) of patients were found to have a significant lesion. This is much less than the 46% (22 of 48) who had a significant lesion identified after a diagnosis of AGC favor neoplasia (P <.001). The patient who had a cervical smear diagnosed as adenocarcinoma-in situ was found to have endometrial adenocarcinoma on cone and endometrial biopsy.