Challenges in managing atypical glandular cells in cervical smears: Insights from real-world data and clinicians' perspectives

Abstract

Objective

This study evaluates clinicopathological outcomes and clinicians' awareness regarding the management of atypical glandular cells (AGC).

Methods

We analyzed 98 AGC cases, excluding known endometrial cancer, from 238 initial cases, with a median age of 42 years (range 20–82). Cytological findings, including NOS and FN subcategories, diagnostic tests, treatments, and outcomes were evaluated. A survey on AGC awareness and practices was conducted among 134 obstetrician-gynecologists.

Results

Of 98 cases (AGC-FN: 19.8%, AGC-NOS: 13.2%, unspecified: 67.3%), 44.9% initially showed no neoplasia; this dropped to 38.8% following up, identifying 11 additional AIS or cervical adenocarcinomas. Overall, 28.5% had AIS or more, 18% had CIN, and 13.3% had other malignancies, indicating some over/underdiagnosis. HPV testing in 79 cases showed a 48.1% positivity rate, including 14 type-18 and 12 type-16 cases. Among clinicians surveyed, 25% were aware of AGC subcategories, and only 11.9% were well-versed. Approximately 65% associated AGC with malignancy or precancerous lesions, and 52.6% used multiple diagnostic methods simultaneously. Even in the absence of neoplasia, 80% continued cytological examinations every 3–4 months.

Conclusion

This study underscores the challenges in AGC management, highlighting the importance of follow-up and collaboration between clinicians and cytopathologists to detect significant lesions. It also emphasizes the need for providing learning opportunities for clinicians to address over/undertreatment.