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Open Access Highly Accessed Research article

Atypical glandular cells in conventional cervical smears: Incidence and follow-up

René Scheiden123*, Catherine Wagener1, Ulrich Knolle1, Walter Dippel2 and Catherine Capesius3

Author Affiliations

1 Division of clinical cytology, National Health Laboratory, L – 1950 Luxembourg

2 Division of pathology, National Health Laboratory, L – 1950 Luxembourg

3 Morphologic Tumour Registry, L – 1950 Luxembourg

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BMC Cancer 2004, 4:37  doi:10.1186/1471-2407-4-37

Published: 19 July 2004

Abstract

Background

Atypical glandular cells on cervical smears are often associated with clinically significant uterine lesions. The frequency and accuracy of AGC-NOS (i.e. atypical glandular cells, not otherwise specified) diagnoses, regardless of the gland cell type or the degree of suspicion, and their outcome were investigated.

Methods

From January 1, 1990 to December 31, 1999 a total of 261 patients had an AGC-NOS diagnosis made by conventional cervical Papanicolaou smear interpretation representing 0.05% of all Pap-smears analyzed at the national level. 191 (73.2%) patients had a subsequent histological examination, 8 samples were not representative by origin and were excluded.

Results

Out of 183 AGC-NOS diagnosed, 56.3% (103/183) were associated with tissue-proven precancerous and/or cancerous lesions, 44% being of endocervical and 56% of endometrial origin. 75% of all AGC-patients were asymptomatic. 66.7% (6/9) of the patients with subsequent invasive endocervical adenocarcinoma (AC) and 56% (28/50) of those patients with invasive endometrial AC were without clinical symptoms. 3 patients out of 9 with an invasive endocervical AC were 35 years of age or less. 10.1% and 12.3% of all 'new' tissue-proven invasive endocervical or endometrial AC respectively recorded by the national Morphologic Tumour Registry (MTR) were first identified by a cytological AGC-NOS diagnosis.

Conclusion

Our findings emphasize the importance of the cytological AGC-category even in the absence of a precise origin or cell type specification. 56% of the AGC-diagnoses being associated with significant cancerous or precancerous conditions, a complete and careful evaluation is required.

Keywords:
AGC-NOS; cervical smears; incidence; time trends; outcome