SGO Researchers Urge Special Treatment of Atypical Glandular Cells Found in Pap Smears

A typical glandular cells detected on cervical Pap smears indicatesignificant cervical pathology in 17% of cases and require animmediate work-up and biopsy, according to research reported inthe October issue of Gynecologic Oncology, the scientificpublication of the Society of Gynecologic Oncologists (SGO).

Although atypical glandular cells of undetermined significance(AGCUS) were found in only 0.2% of the more than 68,000 Pap smearsanalyzed in this 5-year study, compared with 4.5% of smears thathad the more common atypical squamous cells of undetermined significance(ASCUS), AGCUS results were much more ominous. Atypical glandularcells of undetermined significance often indicate infection orreparative changes and frequently only require repeat Pap smears.However, in this study, which reviewed a series of 77 patientswith AGCUS found on cytologic screening examinations, researchersdiscovered underlying cancer and/or significant precancerous lesionsin 17% of evaluated patients.

"Gynecologists aren't seeing a great deal of AGCUS in theiroffices because of its relative rarity. Therefore, women withAGCUS are often lumped into the same triage as ASCUS," saidstudy leader, Alexander W. Kennedy, md, Cleveland Clinic Foundation,Cleveland, Ohio. "But nearly 20% of these AGCUS smears willturn out to have significant abnormalities and need to be treatedimmediately and very differently than women with ASCUS results."

Based on their experience, these researchers have establishedinstitutional guidelines indicating that patients with AGCUS oncytologic screening should undergo immediate, intensive diagnosticstudies, including colposcopy, endocervical curettage, and endometrialbiopsy.

"Cervical adenocarcinomas are increasing in frequency, especiallyin young women. Physicians can't miss this opportunity to detectthese lesions early or at a precancerous stage," said SGOPresident David M. Genhenson, MD.