A typical glandular cells detected on cervical Pap smears indicate
significant cervical pathology in 17% of cases and require an
immediate work-up and biopsy, according to research reported in
the October issue of Gynecologic Oncology, the scientific
publication of the Society of Gynecologic Oncologists (SGO).
Although atypical glandular cells of undetermined significance
(AGCUS) were found in only 0.2% of the more than 68,000 Pap smears
analyzed in this 5-year study, compared with 4.5% of smears that
had the more common atypical squamous cells of undetermined significance
(ASCUS), AGCUS results were much more ominous. Atypical glandular
cells of undetermined significance often indicate infection or
reparative changes and frequently only require repeat Pap smears.
However, in this study, which reviewed a series of 77 patients
with AGCUS found on cytologic screening examinations, researchers
discovered underlying cancer and/or significant precancerous lesions
in 17% of evaluated patients.
"Gynecologists aren't seeing a great deal of AGCUS in their
offices because of its relative rarity. Therefore, women with
AGCUS are often lumped into the same triage as ASCUS," said
study leader, Alexander W. Kennedy, md, Cleveland Clinic Foundation,
Cleveland, Ohio. "But nearly 20% of these AGCUS smears will
turn out to have significant abnormalities and need to be treated
immediately and very differently than women with ASCUS results."
Based on their experience, these researchers have established
institutional guidelines indicating that patients with AGCUS on
cytologic screening should undergo immediate, intensive diagnostic
studies, including colposcopy, endocervical curettage, and endometrial
"Cervical adenocarcinomas are increasing in frequency, especially
in young women. Physicians can't miss this opportunity to detect
these lesions early or at a precancerous stage," said SGO
President David M. Genhenson, MD.