Atypical glandular cells and the real significance in clinical practice: experience of a university hospital in the municipality of Niterói, RJ, Brazil

Abstract

Introduction: Atypical glandular cells (AGC) are rare but clinically significant due to their association with cervical and endometrial lesions. Although human papillomavirus (HPV) is the main etiological agent of cervical lesions, not all AGC are HPV-related, particularly those of endometrial origin. Given the heterogeneity of associated findings, their characterization is essential to guide clinical management. Objective: To describe the distribution of AGC subcategories and evaluate subsequent diagnostic findings, comparing findings between AGC (not otherwise specified) NOS and AGC (favor neoplastic) FN in women evaluated at a Brazilian university hospital. Methods: This is an observational, retrospective, analytical study with a retrospective cohort design, based on the review of cytology reports with an AGC diagnosis and their subsequent diagnostic investigation. Associations between categorical variables were assessed using Fisher’s exact test, with a significance level of 5%. Results: Among 22,246 cytology samples, 161 showed AGC (0.72%). After exclusions, 126 cases were included: 85.7% AGC-NOS and 14.3% AGC-FN. Neoplasia at any site was identified in 22.2% of women and was more frequent in AGC-FN (55.6%) than in AGC-NOS (16.7%) (p=0.001). A statistically significant difference was observed in the distribution of cervical findings between groups (p=0.003), with a higher proportion of neoplastic lesions in AGC-FN. No significant difference was found for endometrial findings (p=0.400). Endocervical cytology was performed in 68 women, showing a significant association between the initial AGC classification and subsequent cytological findings (p=0.003), although 44.4% of AGC-FN cases had negative results. Conclusion: AGC represents a heterogeneous clinical entity, with a higher frequency of neoplastic findings in AGC-FN compared to AGC-NOS, particularly in the cervix. These findings reinforce the importance of a comprehensive diagnostic investigation, particularly in cases classified as AGC-FN. In settings without access to HPV molecular testing, clinical, colposcopic, and histopathological evaluation remains essential.