Clinically Significant Lesions in Women with Atypical Glandular Cells on Cervical Cytology: A Nine-year Retrospective Study

Abstract

Objectives: To determine the incidence of clinically significant lesions in patients with cytologically atypical glandular cells (AGC) in Hong Kong; and to study the association between clinical characteristics and risks of developing clinically significant lesions as well as the long-term impact of cytologically AGC in a patient cohort to make appropriate recommendations for managing these patients.
Methods: A retrospective study in 261 women with cytologically AGC, who were first referred to the colposcopy clinics of the New Territories West Cluster, Hospital Authority, was conducted. Follow-up records, as well as cytological and histological reports, were analysed. Clinically significant lesions were defined as cervical intraepithelial neoplasia 2 or 3, severe glandular dysplasia, atypical endometrial hyperplasia, adenocarcinoma in situ, or invasive carcinoma.
Results: Significant lesions were diagnosed in 77 (30%) patients after referral for cytologically AGC. Twenty-nine (11%) patients had gynaecological cancer. Forty-eight (18%) patients had severe premalignant conditions of the gynaecological tract. Fifty-eight patients (75%) had lesions diagnosed within the first year of referral. Of 229 patients referred for AGC not otherwise specified, 58 (25%) had significant lesions. Of 32 patients referred for AGC-favour neoplasia, 19 (59%) had significant lesions. Presence of concurrent atypical squamous cells of unknown significance (ASCUS) at referral was significantly associated with the diagnosis of genital tract cancer (p=0.02). Concurrent ASCUS at referral was also significantly associated with delayed diagnosis of clinically significant lesions (p=0.01).
Conclusions: Incidence of clinically significant lesions in women with cytologically AGC was high. In particular, concurrent ASCUS at referral conferred an increased risk of clinically significant lesions.