Atypical endocervical cells (AEC) or glandular cells (AGC) of undetermined significance is a rare cytology finding (less than 1% of Australian cervical cytology test results). Previous studies have reported patients with this test result to be at high-risk (17%-59%) for premalignant and malignant cervical disease.
To determine the incidence of histologically confirmed high-grade cervical abnormalities and to investigate clinical practice in patients presenting with atypical endocervical cells of undetermined significance (AEC) on cervical cytology.
This is a 12 year population-based retrospective study examining the prevalence, clinical management and outcomes of patients with AEC on a screening cervical smear. Time to event analysis was used to predict the odds of having or developing in situ and invasive cervical neoplasia.
AEC were reported in index smears from 0.2% patients (1736/795421) during the study period. One hundred thirty nine patients (8.0%) had, or subsequently developed, a high grade cervical lesion. The relative hazard rate of biopsy confirmed high-grade cervical abnormality was five times greater in patients aged 25 to 34 years compared to patients aged 45-54 years (odds ratio 5.3; 95% CI 2.9 - 9.6). Overall, 55.1% of patients underwent evaluation by a specialist obstetrician/ gynecologist with a positive trend in compliance following the implementation of revised management guidelines. The positive predictive value of a high-grade cervical abnormality in patients with AEC increased during the review period.
Cytologic demonstration of AEC requires careful gynaecologic evaluation particularly in younger patients with no cervical screening history and/or having a previously detected low-grade cervical dysplasia.