[Atypical glandular cells (AGC) on Papanicolaou smears--the great challenge of cervix screening programs]

The "grey zone" diagnostic category for glandular cells in the Bethesda System 2001 (TBS 2001) has undergone significant modification since its last version in 1991.

The aim of the study was to follow up patients with "atypical glandular cells of undetermined significance" (AGUS)/ "atypical glandular cells" (AGC), and adenocarcinoma cytological interpretation, based on a three-year material between 2000-2002 at the Department of Cytopathology of National Institute of Oncology, Hungary. The smears were reviewed and interpreted according to TBS 2001. Histological slides were reviewed and cytohistologic correlations were investigated.

Out of 36193 conventional Papanicolaou smears, there were 276 AGC-NOS (AGUS, favour reactive in TBS1991) and 7 AGC-favour neoplastic (AGUS, favour neoplastic in TBS 1991) (altogether 0.78%) and 35 (0.1%) adenocarcinoma interpretations. Histology was available in 136 (AGC-NOS: 106, AGC-favour neoplastic: 7 and adenocarcinoma: 23) cases. Among the followed 106 patients with AGC-NOS, there were 24 cases with concurrent "grey zone" squamous, ASC-US, interpretation. Clinically significant lesions were found in 5/7 (71%) of cases of the AGC-favour neoplastic group, and in 27/106 (25%) of the all AGC-NOS group, the difference is statistically significant. This ratio is 16/82 (20%) in the AGC-NOS only cases, while 11/24 (46%), in the AGC-NOS with concurrent ASC-US cases, the difference is statistically significant. The high-grade lesions were mostly squamous.

The results suggest that AGC-NOS with concurrent ASC-US interpretation represent a group of potential patients with statistically significant higher risk of clinically significant (among them high-grade) lesions.