Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
The Nationwide Network and Registry of Histo-and Cytopathology in the Netherlands (PALGA Foundation), Houten, the Netherlands.
Cancer Epidemiol Biomarkers Prev. 2021 Apr;30(4):743-750. doi: 10.1158/1055-9965.EPI-20-1384. Epub 2021 Feb 9.
Atypical glandular cells (AGC) are rare abnormalities found on cervical cytology associated with a range of lesions of the female reproductive system. We compared the risk of cervical and other gynecologic cancers following AGC on cervical cytology with the risk following squamous cell abnormalities of comparable severity.
We used data from the Dutch Pathology Archive (PALGA) from 2000 to 2015 to categorize cervical cytology tests into groups based on most severe cytologic abnormality and correlated follow-up advice (normal cytology and "no follow-up" advice, squamous-cell-based, AGC-based, and combined AGC/squamous-cell based each with either repeat testing or referral advice). Cancer data were linked from the Netherlands Cancer Registry. Cox proportional hazard models were calculated stratified by age [younger (<50 years) and older (50+ years)], adjusted for number of previous primary cytology tests.
8,537,385 cytology smears and 9,061 cancers were included. When repeat cytology testing was advised, HRs of cervical cancer (younger women: HR, 6.91; 95% CI, 5.48-8.71; older women: HR, 3.98; 95% CI, 2.38-6.66) or other gynecologic cancer diagnosis in younger women (HR, 2.82; 95% CI, 1.39-5.74) were significantly higher after an AGC-based abnormality compared with squamous-based abnormalities. Hazards were also significantly higher for "referral" advice cytology, except for cervical cancer among older women (HR, 0.88; 95% CI, 0.63-1.21).
AGC indicates an increased risk of gynecologic cancer compared with squamous-based abnormalities of comparable severity.
Gynecologists should be alert for cervical and endometrial cancers when examining women referred following AGC.
非典型腺细胞（AGC）是在宫颈细胞学检查中罕见的异常，与女性生殖系统的一系列病变有关。我们比较了宫颈细胞学检查中出现 AGC 与出现严重程度相当的鳞状细胞异常后的宫颈癌和其他妇科癌症风险。
我们使用了 2000 年至 2015 年荷兰病理学档案（PALGA）的数据，根据最严重的细胞学异常对宫颈细胞学检查进行分类，并将随访建议（正常细胞学和“无需随访”建议、基于鳞状细胞的、基于 AGC 的和基于 AGC/鳞状细胞的，每种建议都有重复检测或转诊建议）与后续数据相关联。癌症数据来自荷兰癌症登记处。使用 Cox 比例风险模型计算了分层的年龄（<50 岁和≥50 岁）调整前的细胞学检查次数。
纳入了 8537385 份细胞学涂片和 9061 例癌症。当建议重复细胞学检查时，年轻女性宫颈癌（HR，6.91；95%CI，5.48-8.71；年长女性：HR，3.98；95%CI，2.38-6.66）或其他妇科癌症诊断的风险在 AGC 异常后明显高于鳞状细胞异常。对于“转诊”建议的细胞学检查，风险也明显升高，除了年长女性的宫颈癌（HR，0.88；95%CI，0.63-1.21）。
与严重程度相当的基于鳞状细胞的异常相比，AGC 提示妇科癌症风险增加。
当检查因 AGC 而转诊的女性时，妇科医生应警惕宫颈癌和子宫内膜癌。
