title: Reclassification and analysis of clinical significance of atypical glandular cells on ThinPrep using Bethesda 2001: Geneva experience.
abstract: BACKGROUND
  The category "atypical glandular cells" (AGC) in The Bethesda System (TBS) 2001 represents equivocal glandular atypia. The objective was to determine the clinical significance of diagnosing AGC using new TBS 2001 on Thin-Prep. There is scant information on the diagnosis of AGC and its outcome on ThinPrep using TBS 2001.
  
  
  METHODS
  174 "ThinPrep" Pap tests reported as atypical glandular cells of unknown significance (AGUS) using TBS 1991 during the period (2001-2004) were reclassified using AGC subcategories of TBS 2001. Follow-up histology was correlated with AGC subcategories of TBS 2001 and in women <40 and >or=40 years of age.
  
  
  RESULTS
  The mean AGC rate significantly decreased from 0.7% to 0.3%. (p <0.02). The frequency of clinically significant lesions on followup was higher with AGC diagnosis (51%, 21/41) than AGUS diagnosis (36%, 37/103). It was significantly higher for atypical endocervical cells favouring neoplasia (AEC-FN) (67%, 4/6) and AGC with concurrent squamous intraepithelial lesions (SIL) (67%, 8/12) than for the atypical endocervical cells, not otherwise specified (AECNOS) subcategory (12.5%, 2/16). All clinically significant lesions were high grade squamous intraepithelial lesions (HSIL) in women <40 years but in women >or=40 years, the majority (70%) were glandular. In categories atypical glandular cells favouring neoplasia (AGC-FN) and atypical endometrial cells (AEMC) all women had clinically significant glandular lesions.
  
  
  CONCLUSIONS
  AEC-FN, AGC-FN, AEMC and AGC with concurrent SIL subcategories represented high risk diagnoses. The sequence of further investigations may vary by age and presence of postmenopausal bleeding.
authors.affiliation: Department of Pathology, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Neeta
authors.initials: N
authors.lastname: Kumar
authors.forename: Massimo
authors.initials: M
authors.lastname: Bongiovanni
authors.forename: Marie-José
authors.initials: MJ
authors.lastname: Molliet
authors.forename: Marie-Françoise
authors.initials: MF
authors.lastname: Pelte
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Egger
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Pache
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002584:Cervix Uteri / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D011230:Precancerous Conditions / Q000145:classification* / Q000473:pathology*; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000145:classification* / Q000473:pathology*; D014626:Vaginal Smears / Q000379:methods*