More focus on atypical glandular cells in cervical screening: Risk of significant abnormalities and low histological follow-up rate

Abstract

Objectives: Atypical glandular cells (AGC) detected by Papanicolaou (Pap) smears are in close relation with adenocarcinoma and precursors detected by histopathology. Yet, sometimes the cytological diagnosis of AGC has been neglected. With increase of adenocarcinoma and precursors, we need more focus on glandular abnormalities. Material and Methods: Clinicopathological data of patients who had AGC on Pap smears between April 2015 and October 2018 and underwent histological follow-up were retrieved from the computerized database of Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Patients with a prior history of cancer were excluded from the study. Statistical analyses were performed using Pearson’s Chi-square test in SPSS software version 23. P < 0.05 (two sided) was considered as statistical significance. Results: Liquid-based cytological examination of the uterine cervix was carried out in 164,080 women. Five hundred and twenty-five women were diagnosed with AGC, 314 with not otherwise specified (AGC-NOS), and 211 with favor neoplastic (AGC-FN). Only 310 cases had histological follow-up, 168 women (168/314, 53.5%) originally with AGC-NOS on Pap smears, and 142 (142/211, 67.3%) with AGC-FN. The median age of histological significant abnormalities was 46.7 years, and 126 women (126/162, 77.8%) were postmenopausal. Sixty-six cases (66/168, 39.3%) of AGC-NOS had significant abnormalities (96/142, 67.6%, AGC-FN). One hundred and sixty-two cases of significant abnormalities included 40 high-grade squamous abnormalities and 122 glandular abnormalities. AGC-FN was more likely to be associated with a clinically significant abnormalities (P < 0.001) compared to AGC-NOS. Conclusions: Patients with AGC on Pap smears are in close relation with significant abnormalities, especially with significant glandular abnormalities on histopathology slices. AGC should be evaluated vigilantly with histological workup, especially if patients are diagnosed with AGC-FN and are aged 41–60 years. We need more focus on AGC.