How significant is a cervical smear showing glandular dyskaryosis?
OBJECTIVE
To evaluate the incidence, outcome and predictive value of cytology showing glandular dyskaryosis.


METHODS
Fifty-seven women with a smear diagnosis of glandular dyskaryosis registered between January 1997 and December 2001.


METHODS
Colposcopy and cytopathology units in a large district general hospital.


RESULTS
Sixty smears in 57 women showing glandular dyskaryosis were identified from a cohort of 135,120 smears, giving an incidence of 0.05%. Hospital records were available for 50 women. Final diagnosis included 13 cases of cervical glandular intraepithelial neoplasia (CGIN), 4 microinvasive cervical adenocarcinomas, 2 undifferentiated tumours, 1 microinvasive squamous carcinoma, 21 cases of CIN and 13 cases of endometrial pathology (8 endometrial cancers). Twelve women had coexistent squamous and glandular disease. Forty-five out of 50 women had significant pathology (positive predictive value 90%). Colposcopy was seen to be of limited value in assessment of smears showing glandular dyskaryosis. Only 1 out of 13 glandular lesions was diagnosed by colposcopy.


CONCLUSIONS
Smears showing glandular dyskaryosis are associated with significant pathology in 90% of cases and malignancy in 32% of cases. Hence, women with a smear showing glandular dyskaryosis should be referred urgently to a colposcopy clinic and flagged up as suspected cancer. Glandular dyskaryosis should be included in the national referral criteria for suspected gynaecological cancer.
Pisal
N V
NV
Department of Women's Health, The Whittington Hospital, N19 5NF, London, UK. pisal@dr.com
Sindos
M
M
Desai
S
S
Mansell
E
E
Singer
A
A
D000230:Adenocarcinoma / Q000473:pathology; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000473:pathology; D002584:Cervix Uteri / Q000473:pathology*; D003127:Colposcopy; D016889:Endometrial Neoplasms / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D002583:Uterine Cervical Neoplasms / Q000473:pathology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology