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Delayed Diagnosis After Atypical Glandular Cells on Cervical Cytology

Schnatz, Peter F. DO, FACOG, NCMP1,2,3,4,5,6; Surette, Ann-Marie MD1,3; O'Sullivan, David M. PhD7

Journal of Lower Genital Tract Disease: October 2009 - Volume 13 - Issue 4 - p 237-243
doi: 10.1097/LGT.0b013e3181967387
Original Articles

Objective. This study evaluated the prevalence of clinically significant delayed diagnosis after a negative evaluation for a Pap test with atypical glandular cells (AGCs).

Materials and Methods. From 1998 to 2003, all Pap tests at Hartford Hospital were reviewed. Women with a negative comprehensive evaluation within 12 months of initial AGC cytology were included. Subjects were excluded if they had no uterus, had less than 12 months of follow-up, had a history of AGC, or had known cervical or uterine disease likely to account for the AGC Pap test. A delayed diagnosis was defined as histology of cervical intraepithelial neoplasia (CIN) 2 or greater that was diagnosed more than 12 months from the initial AGC Pap test.

Results. Of the 380,744 Pap tests, 892 (0.23%) had AGCs and 176 met study criteria. Nineteen of the 176 (10.8%) had a delayed diagnosis, including 8 (4.5%) with a malignancy. Women with persistent AGCs had a significantly higher (p <.001) prevalence of a delayed diagnosis. There were 9 patients (5.1%) with CIN 2,3. The remaining diagnoses were classified as a cervical cancer, a glandular disease, or an extrauterine cancer. Women with a cervical cancer or a glandular disease were diagnosed earlier than women with CIN 1,2,3 (p =.041).

Conclusions. Women who developed a delayed cervical cancer or glandular disease were diagnosed significantly earlier than women with a CIN. Women with an AGC Pap test, despite a negative comprehensive evaluation, may be at increased risk for clinically significant disease, especially if they have persistent AGC cytology.

Women with atypical glandular cells on cervical cytology are at risk for a clinically significant delayed diagnosis despite having a negative comprehensive evaluation.

1Department of Obstetrics and Gynecology, 2Department of Internal Medicine, Hartford Hospital, Hartford, CT; 3Department of Obstetrics and Gynecology, 4Department of Internal Medicine, University of Connecticut, Farmington, CT; 5Department of ObGyn, 6Department of Internal Medicine, The Reading Hospital and Medical Center, Reading, PA; and 7Department of Research Administration, Hartford Hospital, Hartford, CT

These data were presented in oral abstract form on March 17, 2008, at the biennial ASCCP meeting in Lake Buena Vista, FL, and received the best overall resident presentation award.

These data and results have not been published.

Funding for analytical services was provided by the Hartford Hospital Medical Staff and Research Program.

There are no conflicts of interest.

Reprint requests to: Peter F. Schnatz, DO, FACOG, NCMP, Associate Chairman and Residency Program Director, The Reading Hospital and Medical Center, Department of OB/GYN-R1; P.O. Box 16052, Reading, PA 19612-6052. Phone: (610) 988-8827; FAX: (610) 988-9292. Email:

©2009The American Society for Colposcopy and Cervical Pathology