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I have a AGC-follow up paper published recently. This is the largest study in this area till now.
Gynecol Oncol. 2009 Sep;114(3):383-9. Epub 2009 Jun 7.
Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213-3180, USA. zhaoc@upmc.edu
OBJECTIVE: Atypical glandular cell (AGC) Pap interpretations and screening for glandular neoplasias remain major challenges. We document the largest reported AGC histopathologic follow-up experience and include verification bias-adjusted data on laboratory screening sensitivity. METHODS: AGC Pap tests of endocervical origin (AGC-EC), endometrial origin (AGC-EM), and not otherwise specified (AGC-NOS) were documented at a center serving an older low risk population. 98% of Pap tests were liquid-based cytology (LBC) specimens screened using computer-assisted screening. Follow-up diagnoses were correlated with cytology and stratified into age groups. Screening sensitivity was assessed by examining Pap results during 1 year preceding neoplastic diagnoses. Verification bias was adjusted with findings in over 2000 patients with hysterectomies. RESULTS: Of 247,131 Pap tests, 1021 (0.41%) reported AGC results and 662 cases had tissue follow-up. Precancerous or malignant neoplastic histologic outcomes were documented in 101 patients (15.3%), including 8.3% cervical, 6.3% endometrial, and 0.6% ovarian. AGC results were most often associated with neoplastic cervical outcomes in women younger than 40 and with neoplastic endometrial outcomes in women 50 or older. AGC-NOS with a squamous cell abnormality and AGC-EC results suggested cervical neoplasia, while AGC-EM results suggested endometrial neoplasia. CONCLUSIONS: AGC Pap results detected significant numbers of cervical and non-cervical neoplasias. Since 38 of 44 (86%) of AGC-detected carcinomas were endometrial or ovarian, HPV co-testing would not have aided screening in detecting the majority of malignancies diagnosed after AGC Pap results. Verification bias-adjusted Pap screening sensitivity in the laboratory for detection of significant neoplastic cervical disease was 93%.
1. We should know the women's LMP, breast cancer type and diagnosed time, detailed treatment history (radiation?).
2. If this patient is not in LMP or within 12 days, At most I may consider to call AGC based on the first photo. The AGC may represent neoplastic lesions or reactive change, especially for this women with history of chemotherapy, 带环 (the patient has or not???).
3. Remember that most women (70-80%) with AGC Pap would have no neoplastic lesions. Again Pap test is a screening test. You must be 100% sure, otherwise please do not call malignant for your pap test, especially for this 35 young lady.
4. if the women is in LMP or within 12 days, we need to think over the meaning of these cells.
5. Breast cancer cells can occour in the Pap smear, but it is very rare.
6. Also we should consider the patient's age. If the young women has both breast and gynecologic tumor, the patient may have BRCA gene mutation.
just for your reference.