The relationship between atypical glandular cells and malignancy risk: a retrospective single-center study

Atypical glandular cells (AGC) in cervical cytology are often ignored, and the malignancy risk associated with AGC remains uncertain. This study aims to evaluate the histopathology and clinical correlations in patients diagnosed with AGC through cervical cytology.

This study was retrospectively analyzed 402 patients who diagnosed with AGC using cervical cytology in our hospital between March 2017 and June 2024. Among these, high-risk human papillomavirus (hrHPV) results and histopathological findings within 1-year follow-up were included.

The distribution of AGC subcategories were as follows: atypical endocervical cells (AEC), 13.4%; atypical endometrial cells, 10.9%; AGC, not otherwise specified, 49.8%; AEC, favor neoplastic, 6.7%; AGC, favor neoplastic, 19.2%. Precancerous lesions and malignancies were diagnosed in 58.9% of cases, with endometrial carcinoma being the most common (24.4%), followed by adenocarcinoma (10.0%). A total of 358 patients underwent hrHPV testing, with a positive rate of 35.2%, hrHPV positivity significantly increased the risk of cervical lesions, while endometrial lesions and pelvic malignancies were more common in hrHPV-negative patients.

This study showed that cytological diagnosis of AGC has high predictive value for cervical lesions, endometrial lesions, and pelvic malignancies. A more detailed triage procedure based on the AGC subcategory can reduce the possibility of missed diagnoses of reproductive tract tumors. The combination of hrHPV detection and age can serve as an important basis for the further diagnosis and management of AGC.