Role of Cervical Cytology in the Detection of Uterine Glandular Lesions

Background: Diagnosis of atypical glandular cells (AGCs) is challenging to the cytopathologist due to the overlapping features of various neoplastic and nonneoplastic lesions. The aim of this study was to assess the utility of conventional Papanicolaou (Pap) smears in detecting uterine glandular lesions. Materials and Methods: Archived records of all histopathologically diagnosed endometrial adenocarcinoma and endocervical adenocarcinoma during the study period were identified. Corresponding Pap smears, if available, were retrieved. In addition, all cytologically reported AGCs and adenocarcinoma during the same period were retrieved. Pap smears of histopathology discordance cases were reviewed. The prevalence of AGC and sensitivity and specificity of Pap smears in detecting glandular lesions were calculated. Results: The prevalence of AGC was 0.65%. There were 11 false negatives and 10 false positives initially, which were reduced to 6 and 5, respectively, after the review. The sensitivity and specificity of Pap smear in detecting AGC was 72.9% and 99.81% initially, which improved marginally to 81.8% and 99.9%, respectively. Conclusions: The prevalence of AGC in Pap smears is low with a moderate sensitivity and good specificity. As the association of clinically significant lesion is high, all cases with AGC diagnosis must be followed up with colposcopic and histopathologic examination of uterus and cervix.