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 biopsy.
"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.