Yucel Polat Aysegul, Tepeoglu Merih, Tunca Muzeyyen Zeynep, Ayva Ebru Sebnem, Ozen Ozlem
Department of Pathology, Faculty of Medicine, Baskent University, Ankara, Turkey.
Cytopathology. 2021 May;32(3):344-352. doi: 10.1111/cyt.12957. Epub 2021 Mar 10.
Atypical glandular cells (AGCs) in Pap (Papanicolaou) smears are uncommon but may represent various benign and malignant lesions. The aim of this study was to evaluate the AGC incidence in Pap smears, analyse the relationship between AGC and malignancy, and reveal the importance of architectural and nuclear features observed cytologically in malignancies.
Patients diagnosed with AGC on the basis of cervicovaginal cytology between May 2011 and July 2018 were included in this study. All slides were retrospectively reviewed and subclassified according to the Bethesda 2001 classification system. The cytomorphological features observed in the smears were recorded. Cytohistological correlations were evaluated, and the significant clinicopathological findings for malignancy were determined.
Of 87 536 Pap smears, 195 (0.22%) had AGC results and 156 had tissue follow-up. Among the 156 smears with AGC, 80 (51.3%) were diagnosed as AGC-NOS (atypical glandular cells, not otherwise specified) and 76 (48.7%) as AGC-FN (atypical glandular cells, favour neoplastic). Follow-up biopsies revealed benign pathologies in 49 cases (31.4%) and malignant pathologies in 107 (68.6%). The rate of malignancy observed in AGC-FN cases (89.5%) was higher than the rate of malignancy in AGC-NOS cases (48.8%). Among the cytomorphological features, nuclear irregularity, presence of macronucleoli, feathering, loss of polarity, papillary pattern, and three-dimensional formation were found to be significant indicators of malignancy.
As AGC in Pap smear was associated with a clinically significant diagnosis in 68.6% of the cases in our study, we suggest that all patients with AGC should undergo further clinical assessment.
巴氏涂片检查中的非典型腺细胞（AGC）并不常见，但可能代表各种良性和恶性病变。本研究的目的是评估巴氏涂片中AGC的发生率，分析AGC与恶性肿瘤之间的关系，并揭示细胞学观察到的结构和核特征在恶性肿瘤中的重要性。
本研究纳入了2011年5月至2018年7月期间根据宫颈阴道细胞学诊断为AGC的患者。所有玻片均进行回顾性审查，并根据2001年贝塞斯达分类系统进行亚分类。记录涂片中观察到的细胞形态学特征。评估细胞组织学相关性，并确定恶性肿瘤的重要临床病理结果。
在87536例巴氏涂片中，195例（0.22%）AGC检查结果阳性，156例进行了组织学随访。在156例AGC涂片病例中，80例（51.3%）被诊断为AGC-NOS（非典型腺细胞，未另行指定），76例（48.7%）被诊断为AGC-FN（非典型腺细胞，倾向肿瘤性）。随访活检显示49例（31.4%）为良性病变，107例（68.6%）为恶性病变。AGC-FN病例的恶性率（89.5%）高于AGC-NOS病例（48.8%）。在细胞形态学特征中，核不规则、存在大核仁、羽毛状、极性丧失、乳头样模式和三维结构被发现是恶性肿瘤的重要指标。
由于在我们的研究中，巴氏涂片中的AGC在68.6%的病例中与具有临床意义的诊断相关，我们建议所有AGC患者都应接受进一步的临床评估。
