Cervical cytology: Evaluation of atypical and malignant glandular cells
- Annekathryn Goodman, MD
Annekathryn Goodman, MD
- Associate Professor
- Harvard Medical School
- Warner K Huh, MD
Warner K Huh, MD
- Margaret Cameron Spain Chair in Obstetrics/Gynecology
- Professor, Division of Gynecologic Oncology
- Senior Scientist, UAB Comprehensive Cancer Center
Cervical cytology became the standard screening test for cervical cancer and premalignant cervical lesions with the introduction of the Papanicolaou (Pap) smear in 1941 . Liquid-based, thin layer preparation (eg, ThinPrep, SurePath) of cervical cytology specimens was a subsequent modification in technique.
Atypical glandular cells on cervical cytology usually originate from the glandular epithelium of the endocervix or endometrium. Atypical glandular cells are found less commonly than abnormal squamous cells. Women with atypical glandular cells require further evaluation for premalignant conditions of the cervix, uterus, and rarely, ovary.
Evaluation of women with cervical cytology with atypical or malignant glandular cells is reviewed here. Cervical cancer screening strategies and techniques, interpretation of cervical cytology results, follow-up of other abnormal cytology results, and management of cervical neoplasia are discussed separately. (See "Screening for cervical cancer" and "Cervical cancer screening tests: Techniques for cervical cytology and human papillomavirus testing" and "Cervical and vaginal cytology: Interpretation of results (Pap test report)" and "Cervical cytology: Evaluation of atypical squamous cells (ASC-US and ASC-H)" and "Cervical cytology: Evaluation of low-grade squamous intraepithelial lesions (LSIL)" and "Cervical cytology: Evaluation of high-grade squamous intraepithelial lesions (HSIL)" and "Cervical intraepithelial neoplasia: Management of low-grade and high-grade lesions".)
Terminology for reporting cervical cytology was standardized by the Bethesda System in 1988 . This system has been revised several times and the current system was developed in 2001 (table 1) [3,4]. The terminology used to classify atypical glandular cells is:
●Atypical glandular cells (AGC) – Endocervical, endometrial, or not otherwise specified (NOS) is noted as a subcategory. This replaces the previous term "atypical glandular cells of undetermined significance (AGUS)." This term should not be confused with terminology for squamous cell abnormalities, which includes atypical squamous cells of undetermined significance (ASC-US). (See "Cervical and vaginal cytology: Interpretation of results (Pap test report)", section on 'Intraepithelial cell abnormalities'.)
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- http://www.asccp.org/ (Accessed on March 22, 2012).
- RISK OF PREMALIGNANT OR MALIGNANT DISEASE
- Histology and site of lesion
- Modifying factors
- - AGC subcategory
- - Coexisting squamous cytologic abnormality
- - Human papillomavirus infection
- - Age
- - Other factors
- INITIAL EVALUATION
- All AGC categories (except endometrial)
- NEGATIVE OR LOW-GRADE FINDINGS ON INITIAL EVALUATION
- AGC-NOS or endocervical
- - Persistent abnormal cytology
- AGC favor neoplasia, AIS, adenocarcinoma
- EVALUATION FOR OVARIAN CANCER OR OTHER MALIGNANCIES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS