The Mystery of Atypical Glandular Cells in Cervical Cytology: Histopathologic and Clinical Correlation

Abstract

Introduction: The current standard practice to help identify endometrial carcinoma (EC) on Papanicolaou (Pap) test is to document “endometrial cells in women 40 years of age” (E40). Since a significant fraction of women in this category are still menstruating, the presence of endometrial cells correlates with menstrual history and is likely not pathologic. Routine biopsy following E40 may lead to unnecessary procedures and costs. Therefore, setting a different age threshold in combination with other findings may help to guide management. Materials and Methods: A retrospective chart review was performed on consecutive EC biopsies (2007-2013) and E40 Paps (2012-2013). Clinicopathologic data included age, biopsy (reason, diagnosis, FIGO grade, time since Pap), Pap diagnosis, HPV status, and resection (diagnosis, depth of invasion, stage, and metastasis). Results: One hundred EC cases had 62 prior Pap diagnoses: negative for intraepithelial lesion (27/62), atypical glandular cells of undetermined significance (14/62), adenocarcinoma (10/62), and E40 (1/62; 51 years). 370 E40 cases had 68 biopsies (18%) and 2 hysterectomies (0.5%). E40 prompted biopsy in 26/68 (38%). 2/68 (3%) biopsied women had EC (50 and 60 years, both post-menopausal). 1/68 had complex hyperplasia with atypia (52 years; abnormal uterine bleeding [AUB]), and 3/68 had complex hyperplasia without atypia (ages 52, 40, and 58; AUB). Conclusions: Analysis of women with EC revealed 2% with E40 on prior pap testing. Analysis of E40 cases showed the majority correlated with menstrual history or did not prompt biopsy. Only 18% were biopsied, with EC in 3%. In asymptomatic women <50 years, E40 correlated with benign, non-hyperplastic endometrium. However, postmenopausal women with E40 had a risk of EC. These findings suggest that E40 diagnoses on Pap tests in asymptomatic pre-menopausal women may not warrant further work-up. Perhaps endometrial cells should only be reported in post-menopausal women or women 50 years of age.