Baystate Medical Center, Springfield, Massachusetts, USA.
Cancer Cytopathol. 2013 Jan;121(1):47-53. doi: 10.1002/cncy.21211. Epub 2012 Jun 12.
Atypical glandular cells (AGC) on cervical cytology are high-risk, requiring an extensive evaluation. Compliance with practice guidelines for AGC, however, has been low. Some AGC cytology reports contain cytopathologist recommendations for evaluation. This study determines whether evaluation rates for AGC have improved over time, and whether cytopathologists' recommendations correlate with the types of evaluation women receive.
Evaluation rates from 284 women with AGC (2004-2007) were compared with findings from 1998-2001. Rates of evaluations were compared based on cytology report recommendations.
A total of 76.1% of the AGC cases had histologic sampling, and 58.8% had a comprehensive evaluation. These rates are higher than those from 1998-2001 (63.5% and 35.8%, respectively; P<.01). Rates of evaluations of women with AGC "favor neoplasia" did not increase between the 2 time periods. Between 2004-2005 and 2006-2007, rates of comprehensive initial evaluations and endometrial sampling in women ≥35 years of age did not increase. Of the AGC reports that did contain cytopathologist recommendations, 28% were consistent with practice guidelines, 26% recommended an incomplete histologic evaluation, and 46% recommended repeat cytology. Women whose AGC report recommended a comprehensive evaluation or any histologic evaluation were more likely to have a comprehensive work-up (79%) than those whose reports did not contain recommendations (55%, P <0.01) or recommended repeat cytology (51%, P<0.02).
Adherence to practice guidelines for the evaluation of women with AGC has improved but continues to be suboptimal. Our findings suggest that continuing education and including practice guidelines on AGC cytology reports may improve compliance.
宫颈细胞学检查中的非典型腺细胞（AGC）为高风险，需要广泛评估。然而，对 AGC 实践指南的遵循率一直较低。一些 AGC 细胞学报告包含细胞病理学家对评估的建议。本研究旨在确定随着时间的推移，对 AGC 的评估率是否有所提高，以及细胞病理学家的建议是否与女性接受的评估类型相关。
将 2004-2007 年 284 例 AGC 患者的评估率与 1998-2001 年的结果进行比较。根据细胞学报告建议比较评估率。
共有 76.1%的 AGC 病例进行了组织学取样，58.8%进行了全面评估。这些比率高于 1998-2001 年的比率（分别为 63.5%和 35.8%；P<.01）。在这两个时期，“倾向于肿瘤”的 AGC 女性的评估率并未增加。在 2004-2005 年至 2006-2007 年期间，≥35 岁女性的全面初始评估和子宫内膜取样率没有增加。在包含细胞病理学家建议的 AGC 报告中，28%符合实践指南，26%建议进行不完全的组织学评估，46%建议重复细胞学检查。其 AGC 报告建议全面评估或任何组织学评估的女性更有可能接受全面检查（79%），而那些报告未包含建议（55%，P<0.01）或建议重复细胞学检查（51%，P<0.02）的女性。
对 AGC 女性评估的实践指南的遵循率有所提高，但仍不理想。我们的研究结果表明，持续的教育和在 AGC 细胞学报告中包含实践指南可能会提高其遵循率。
