Risk of high-grade cervical dysplasia and gynaecological malignancies following the cytologic diagnosis of atypical endocervical cells of undetermined significance: A retrospective study of a state-wide screening population in Western Australia.

Background In 2006, Australia adopted a revised cervical cytology terminology system, known as the Australian Modified Bethesda System ( AMBS). One substantial change in the AMBS was the introduction of the diagnostic category of atypical endocervical cells ( AEC) of undetermined significance. Aim The aim of this study was to investigate the incidence of histologically confirmed high-grade cervical dysplasia (cervical intra-epithelial neoplasia ( CIN) grades 2 and 3 and adenocarcinoma in situ ( ACIS)), cervical carcinoma and endometrial carcinoma in women presenting with AEC on cervical cytology. Methods A seven-year retrospective study examining clinical outcomes of women with AEC on a screening cervical smear. Cytology and histology results were extracted from the Western Australia Cervical Screening Registry, and time-to-event analysis was used to predict the odds of having or developing in situ and invasive neoplasia. Results AEC was reported in index smears from 0.093% (584/622754) women during the study period. No follow-up was available in 35 AEC cases. Sixty-five of the remaining 549 women (11.8%) had, or developed, high-grade cervical dysplasia within five years of their index AEC diagnosis. Endometrial cancer was diagnosed in 21 women and cervical cancer in four women during the follow-up period. Conclusion Cytologic demonstration of AEC requires careful gynaecologic evaluation, particularly in younger women who may be found to have either high-grade squamous ( CIN) or glandular ( ACIS) lesions, while in older women, the possibility of endometrial neoplasia needs to be considered. [ABSTRACT FROM AUTHOR]