Clinical significance of atypical glandular cells in conventional pap smears in a large, high-risk U.S. west coast minority population.
OBJECTIVE
To determine the incidence of clinically significant lesions on subsequent histologic follow-up in high-risk, predominantly minority patients with atypical glandular cells (AGC).


METHODS
A retrospective study was done on conventional Pap smears diagnosed as AGC of endocervical origin (AGC-EC), AGC of endometrial origin (AGC-EM) and AGC not otherwise specified (AGC-NOS) between January 1, 2003, and December 31, 2005. Histologic diagnoses were correlated with cytologic diagnoses.


RESULTS
Confirmed AGC cases were divided into 4 categories: 187 AGC-NOS, 169 AGC-EC, 68 AGC and atypical squamous cells of undetermined significance (ASCUS) and 36 AGC-EM. A total of 105 patients (22.8%) had significant precancerous (cervical intraepithelial neoplasia [CIN] 2/3, adenocarcinoma in situ [AIS]) or malignant (carcinoma) histologic outcomes. CIN 2/3 was the most common significant histologic outcome in women with AGC and ASCUS and patients <35 years with AGC. Endometrial neoplasia was the most common significant outcome in women with AGC-NOS and AGC-EM Pap results and in AGC patients > or =35. In women with AGC-EC Pap results, glandular cervical neoplasia occurred in 8.3% and CIN 2/3 in 5.9% offollow-up biopsies.


CONCLUSIONS
AGC subtype and age significantly affect the probability of precancerous and malignant follow-up findings and anatomic site of neoplastic lesions. Access to newer screening technologies such as high-risk HPVDNA testing and liquid-based cytology will likely benefit such high-risk populations.
Department of Pathology, Los Angeles County and University of Southern California Medical Center, USA. zhaoc@upmc.edu
Chengquan
C
Zhao
R Marshall
RM
Austin
Jianqiu
J
Pan
Nancy
N
Barr
Sue E
SE
Martin
Anwar
A
Raza
Camilla
C
Cobb
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D006801:Humans; D008875:Middle Aged; D008913:Minority Groups; D065006:Papanicolaou Test; D011230:Precancerous Conditions / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000473:pathology*