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 AustraliaAustralian and New Zealand Journal of Obstetrics and Gynaecology (2015)
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-toevent
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.
Citation InformationMunro, A., Williams, V., Semmens, J., Leung, Y., Stewart, C., Codde, J.P., Spilsbury, K., Steel, N., Cohen, P., and O'Leary, P. (2015). 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. Australian and New Zealand Journal of Obstetrics and Gynaecology, 55, 268-273. DOI: 10.1111/ajo.12336