The significance of atypical glandular cells on routine cervical cytologictesting in a community-based population

OBJECTIVES: We sought to determine the follow-up rate of women with glandul ar atypia on routine Papanicolaou smears in a community-based population an d to describe the associated pathologic findings. STUDY DESIGN: Over a 12-month period, all patients with Papanicolaou smears with atypical glandular cells of undetermined significance were reviewed f or demographic and clinical characteristics and followed up for a period of 12 to 24 months. RESULTS: Of the 48,890 Papanicolaou smears examined, 141 (0.29%) were diagn osed with atypical glandular cells of undetermined significance. Of these, 22 (17.6%) had no record of any subsequent investigation, and only 64 (51.2 %) were monitored with both colposcopy and biopsy. Of the 64 biopsy specime ns, 39 (60.9%) were positive for disease. Twenty-six (66.7%) were of squamo us origin, with the most advanced lesion being cervical intraepithelial neo plasia 3. An additional patient had a combined cervical intraepithelial neo plasia and adenocarcinoma in situ lesion. Four (10.3%) additional patients had glandular cervical lesions, 2 benign polyps and 2 adenocarcinoma in sit u lesions. Seven (17.9%) patients had endometrial lesions (benign polyps, 2 patients; complex atypical endometrial hyperplasia, 1 patient; and endomet rial carcinoma, 4 patients). One patient had ovarian cystadenocarcinoma. Po stmenopausal women were 5 times more likely to have a glandular lesion. Wom en with abnormal vaginal bleeding were also more likely to have a glandular lesion. These same patient groups were also more likely to have endometria l disease. CONCLUSION: The incidence of atypical glandular cells of undetermined signi ficance on Papanicolaou smears in this community-based population was 0.29% , which is consistent with estimates from institution-based populations. Ne arly 50% of women studied were not followed up with tissue biopsy. Of those with a tissue biopsy, 61% had positive findings, including 5 with cancer. Although postmenopausal status and abnormal vaginal bleeding were associate d with endometrial or glandular disease, studies of larger patient populati ons should be conducted to examine potential risk factors for these conditi ons.