title: Risk of high-grade cervical dysplasia and gynaecological malignancies following the cytologic diagnosis of atypical endocervical cells of undetermined significance: a retrospective study of a state-wide screening population in Western Australia.
abstract: BACKGROUND
  In 2006, Australia adopted a revised cervical cytology terminology system, known as the Australian Modified Bethesda System (AMBS). One substantial change in the AMBS was the introduction of the diagnostic category of atypical endocervical cells (AEC) of undetermined significance.
  
  
  OBJECTIVE
  The aim of this study was to investigate the incidence of histologically confirmed high-grade cervical dysplasia (cervical intra-epithelial neoplasia (CIN) grades 2 and 3 and adenocarcinoma in situ (ACIS)), cervical carcinoma and endometrial carcinoma in women presenting with AEC on cervical cytology.
  
  
  METHODS
  A seven-year retrospective study examining clinical outcomes of women with AEC on a screening cervical smear. Cytology and histology results were extracted from the Western Australia Cervical Screening Registry, and time-to-event analysis was used to predict the odds of having or developing in situ and invasive neoplasia.
  
  
  RESULTS
  AEC was reported in index smears from 0.093% (584/622754) women during the study period. No follow-up was available in 35 AEC cases. Sixty-five of the remaining 549 women (11.8%) had, or developed, high-grade cervical dysplasia within five years of their index AEC diagnosis. Endometrial cancer was diagnosed in 21 women and cervical cancer in four women during the follow-up period.
  
  
  CONCLUSIONS
  Cytologic demonstration of AEC requires careful gynaecologic evaluation, particularly in younger women who may be found to have either high-grade squamous (CIN) or glandular (ACIS) lesions, while in older women, the possibility of endometrial neoplasia needs to be considered.
authors.affiliation: Women's Health Clinical Care Unit, WA Cervical Cancer Prevention Program, Perth, Western Australia, Australia.
authors.forename: Aime
authors.initials: A
authors.lastname: Munro
authors.affiliation: School of Biomedical Sciences, Curtin University, Perth, Western Australia, Australia.
authors.forename: Vincent
authors.initials: V
authors.lastname: Williams
authors.affiliation: Centre for Population Health Research, Curtin University, Perth, Western Australia, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Semmens
authors.affiliation: School of Women's and Infants' Health, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Yee
authors.initials: Y
authors.lastname: Leung
authors.affiliation: School of Women's and Infants' Health, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Colin J R
authors.initials: CJ
authors.lastname: Stewart
authors.affiliation: Centre for Population Health Research, Curtin University, Perth, Western Australia, Australia.
authors.forename: Jim
authors.initials: J
authors.lastname: Codde
authors.affiliation: Centre for Population Health Research, Curtin University, Perth, Western Australia, Australia.
authors.forename: Katrina
authors.initials: K
authors.lastname: Spilsbury
authors.affiliation: Women's Health Clinical Care Unit, WA Cervical Cancer Prevention Program, Perth, Western Australia, Australia.
authors.forename: Nerida
authors.initials: N
authors.lastname: Steel
authors.affiliation: School of Women's and Infants' Health, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Cohen
authors.affiliation: Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: O'leary
mesh_terms: D065311:Adenocarcinoma in Situ / Q000453:epidemiology* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002277:Carcinoma / Q000453:epidemiology* / Q000473:pathology; D002584:Cervix Uteri / Q000473:pathology*; D055088:Early Detection of Cancer; D016889:Endometrial Neoplasms / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000473:pathology
keywords: Papanicolaou smear; atypical endocervical cells; atypical glandular cells; cervical cancer; cervical cytology; cervical screening; endometrial cancer