A Pap test may sometimes reveal atypical glandular cells (AGC). These glandular cells, originating from the inner cervix or uterine lining, show atypical changes. While AGC is not a cancer diagnosis, these abnormal cells require further investigation to determine their underlying cause.
Understanding Atypical Glandular Cells
Atypical glandular cells (AGC) are abnormal cells found during a Pap test that originate from glandular tissue. These differ from squamous cells, which cover the outer cervix and are more commonly associated with Pap test abnormalities. Glandular cells produce mucus and line the endocervical canal and the uterine lining (endometrium).
AGC detection is less common than squamous cell abnormalities, occurring in under 1% of cervical cytology specimens. This broad category includes benign, reactive changes, which are often non-threatening. However, AGC can also signal more serious conditions, such as pre-cancerous lesions like adenocarcinoma in situ (AIS) or invasive adenocarcinoma. The specific type and origin of these atypical cells, whether from the endocervix or endometrium, guide clinical management.
Can Atypical Glandular Cells Resolve Naturally?
Whether atypical glandular cells resolve on their own is a common concern. While some benign cellular changes, like those from inflammation, might resolve, AGC findings always require further evaluation. Unlike low-grade squamous cell abnormalities that often clear spontaneously, AGC spontaneous resolution is much less common.
Healthcare providers do not recommend a “watch and wait” approach for AGC. This is because these abnormal cells can be associated with serious underlying conditions, including pre-cancerous changes or invasive cancer. Studies indicate a significant percentage of AGC cases link to serious pathology, from high-grade pre-invasive lesions to invasive carcinomas. Therefore, immediate and thorough investigation is the standard approach to understand the atypical cells, rather than waiting for them to disappear.
Navigating an Atypical Glandular Cell Diagnosis
Upon receiving an atypical glandular cell (AGC) diagnosis, a detailed follow-up plan identifies the source and nature of the abnormal cells. A common initial step is a colposcopy, which uses a magnifying instrument to examine the cervix, vagina, and vulva for abnormal cell growth. During colposcopy, the provider identifies areas of concern and takes targeted biopsies of cervical tissue for microscopic examination.
In addition to colposcopy, endocervical sampling, often called an endocervical curettage (ECC), is frequently performed to collect cells from the inner cervical canal. For women over 35 or those with risk factors like abnormal uterine bleeding, an endometrial biopsy is also recommended to examine the uterine lining. This is because AGC can originate from the endometrium and may be associated with endometrial cancer or its precursors.
Human papillomavirus (HPV) testing also plays a role in AGC evaluation. While HPV links more strongly to squamous cell abnormalities, high-risk HPV types can associate with certain AGC types and a higher risk of significant lesions, including cervical adenocarcinoma. HPV-negative AGC can also associate with serious conditions, including endometrial cancer; therefore, HPV testing alone is not sufficient to rule out significant pathology. These comprehensive tests help determine if the AGC is benign or indicative of a more serious pre-cancerous or cancerous condition.
Why Follow-Up is Essential
Consistent medical follow-up after an atypical glandular cell (AGC) diagnosis is important. While some AGC findings may be benign, a significant percentage associate with pre-cancerous lesions or invasive cancers. Studies indicate that 9% to 38% of AGC cases link to high-grade cervical intraepithelial neoplasia (CIN2, CIN3) or adenocarcinoma in situ (AIS). Additionally, 3% to 17% can associate with invasive carcinomas.
The risk of invasive malignancy with an AGC diagnosis is reported as high as 2% to 5%. AGC’s potential as a marker for underlying cancer is considered higher than for some other abnormal Pap test results, such as high-grade squamous intraepithelial lesions (HSIL). Early detection through follow-up allows for timely intervention, which significantly improves outcomes. Regular monitoring and appropriate diagnostic procedures identify and address serious conditions before they advance.