High‐grade cervical abnormality following the cytologic diagnosis of atypical endocervical cells of undetermined significance: a retrospective study of 1736 cases

Background: 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.
Aim: 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.
Methods: 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.
Results: 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.
Conclusions: 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.