Clinical evaluation of atypical glandular cells of undetermined significance

OBJECTIVE: This study was undertaken to determine the clinical implications of the finding of atypical glandular cells of undetermined significance in cervical cytologic specimens in our patient population. STUDY DESIGN: A retrospective study was performed. All cervical cytologic e xaminations with the diagnosis of atypical cells of undetermined significan ce between January 1992 and June 1997 were identified by means of a compute rized database. Medical records were reviewed to identify patient demograph ic characteristics and to determine the presence or absence or associated p athologic conditions of the cervix and endometrium. The chi (2) test and an alysis of Variance were applied to dichotomous and continuous variables, re spectively, to determine the implications of a cytologic evaluation of atyp ical glandular cells of undetermined significance. RESULTS: Cytologic results reported as atypical glandular cells of undeterm ined significance were obtained in a patient cohort of 492. Atypical glandu lar cells of undetermined significance was the only cytologic diagnosis in 224 patients; 268 patients had both atypical glandular cells of undetermine d significance and an additional squamous abnormality, including atypical s quamous cells of undetermined significance and cervical intraepithelial neo plasia I, II, or III. Two patients were excluded because of a history of en dometrial cancer. A histologic evaluation was obtained within 1 year in 353 cases. Among the 353 patients who had a histologic evaluation performed, 2 27 (64%) had benign cervical and endometrial findings. There were 18 glandu lar lesions (5%), including complex hyperplasia with atypia, adenocarcinoma in situ of the cervix, adenocarcinoma of the cervix, and adenocarcinoma of the endometrium. A squamous lesion was present in 108 patients (31%). Most squamous lesions (81%) were found in patients with atypical glandular cell s of undetermined significance associated with a squamous abnormality, wher eas only 19% were found in patients with atypical glandular cells of undete rmined significance as the only diagnosis. Women <35 years old had a much h igher frequency of histologic abnormalities than did women >50 years old (P < .0001), with mast of these lesions being squamous. Women >50 years old h ad a much higher frequency of glandular histologic abnormalities (P < .001) . CONCLUSION: More than a third of women with Papanicolaou smears reported as showing atypical glandular cells of undetermined significance will be foun d to have a histologic abnormality. Women <35 years old with a cytologic ev aluation of atypical glandular cells of undetermined significance have a hi gher frequency of histopathologic findings, with most being squamous lesion s. Women with a cytologic evaluation of atypical glandular cells of undeter mined significance who are >50 years old have more glandular lesions than d o younger women. The term atypical glandular cells of undetermined signific ance is a misnomer. The significance of this cytologic finding has been def ined and represents a marker for serious pathologic processes.