The journal of obstetrics and gynaecology research · 2025
Challenges in managing atypical glandular cells in cervical smears: Insights from real-world data and clinicians' perspectives.
СтатьяНазвание и аннотация: Перевод в очереди
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Mizuno Mika, Nakazono Mai, Furuzono Nozomi, Kobayashi Yusuke, Fukuda Mika, Togami Shinichi, Kobayashi Hiroaki
Аннотация
OBJECTIVE: This study evaluates clinicopathological outcomes and clinicians' awareness regarding the management of atypical glandular cells (AGC).
METHODS: We analyzed 98 AGC cases, excluding known endometrial cancer, from 238 initial cases, with a median age of 42 years (range 20-82). Cytological findings, including NOS and FN subcategories, diagnostic tests, treatments, and outcomes were evaluated. A survey on AGC awareness and practices was conducted among 134 obstetrician-gynecologists.
RESULTS: Of 98 cases (AGC-FN: 19.8%, AGC-NOS: 13.2%, unspecified: 67.3%), 44.9% initially showed no neoplasia; this dropped to 38.8% following up, identifying 11 additional AIS or cervical adenocarcinomas. Overall, 28.5% had AIS or more, 18% had CIN, and 13.3% had other malignancies, indicating some over/underdiagnosis. HPV testing in 79 cases showed a 48.1% positivity rate, including 14 type-18 and 12 type-16 cases. Among clinicians surveyed, 25% were aware of AGC subcategories, and only 11.9% were well-versed. Approximately 65% associated AGC with malignancy or precancerous lesions, and 52.6% used multiple diagnostic methods simultaneously. Even in the absence of neoplasia, 80% continued cytological examinations every 3-4 months.
CONCLUSION: This study underscores the challenges in AGC management, highlighting the importance of follow-up and collaboration between clinicians and cytopathologists to detect significant lesions. It also emphasizes the need for providing learning opportunities for clinicians to address over/undertreatment.
METHODS: We analyzed 98 AGC cases, excluding known endometrial cancer, from 238 initial cases, with a median age of 42 years (range 20-82). Cytological findings, including NOS and FN subcategories, diagnostic tests, treatments, and outcomes were evaluated. A survey on AGC awareness and practices was conducted among 134 obstetrician-gynecologists.
RESULTS: Of 98 cases (AGC-FN: 19.8%, AGC-NOS: 13.2%, unspecified: 67.3%), 44.9% initially showed no neoplasia; this dropped to 38.8% following up, identifying 11 additional AIS or cervical adenocarcinomas. Overall, 28.5% had AIS or more, 18% had CIN, and 13.3% had other malignancies, indicating some over/underdiagnosis. HPV testing in 79 cases showed a 48.1% positivity rate, including 14 type-18 and 12 type-16 cases. Among clinicians surveyed, 25% were aware of AGC subcategories, and only 11.9% were well-versed. Approximately 65% associated AGC with malignancy or precancerous lesions, and 52.6% used multiple diagnostic methods simultaneously. Even in the absence of neoplasia, 80% continued cytological examinations every 3-4 months.
CONCLUSION: This study underscores the challenges in AGC management, highlighting the importance of follow-up and collaboration between clinicians and cytopathologists to detect significant lesions. It also emphasizes the need for providing learning opportunities for clinicians to address over/undertreatment.