Cytomorphological and immunohistochemical predictors of neoplastic pathology in atypical glandular cells detected in cervical cytology: a 10-year retrospective cohort study.

Authors

Esra Keles, Sahra Sultan Kara, Pınar Birol İlter, Mervenur Sahin, Sibel Çetinkaya

Published in

Journal of the American Society of Cytopathology. Aug 05, 2026. Epub Aug 05, 2026.

Abstract

To evaluate histopathological outcomes following a diagnosis of atypical glandular cells (AGC) and identify independent predictors of neoplastic pathology.
This retrospective cohort study included patients diagnosed with AGC on cervical cytology between January 2013 and December 2023 at a tertiary gynecologic oncology center. Cases with histopathological follow-up within 12 months were included. Cytology slides were rereviewed according to the 2014 Bethesda System. Clinical characteristics, cytomorphological features, p16/Ki67 immunohistochemical status on follow-up tissue specimens, and histopathological outcomes were analyzed. Multivariable logistic regression and receiver operating characteristic analyses were performed.
AGC was identified in 141 of 128,022 cytology specimens (0.11%). After exclusions, 119 patients were analyzed. Neoplastic pathology was detected in 28 cases (23.5%), including endometrial carcinoma (39.3%), cervical neoplasia (35.7%), metastatic malignancies (17.9%), and ovarian high-grade serous carcinoma (7.1%). Neoplastic outcomes were significantly associated with increasing age, postmenopausal status, p16/Ki67 positivity, increased nuclear-to-cytoplasmic ratio, nuclear enlargement, and loss of polarity. Multivariable analysis identified increasing age (odds ratio [OR]: 1.141, 95% confidence interval [CI]: 1.072-1.214; P < 0.001), p16/Ki67 positivity (OR: 7.321, 95% CI: 1.828-29.318; P = 0.005), and loss of polarity (OR: 16.873, 95% CI: 4.012-70.953; P < 0.001) as independent predictors of neoplastic pathology. The predictive model demonstrated excellent discrimination (area under the curve = 0.918).
Nearly one-quarter of AGC cases harbored neoplastic pathology. Increasing age, p16/Ki67 positivity, and loss of polarity independently predicted neoplastic outcomes. Integration of these parameters with thorough clinical history may improve risk stratification and clinical management of patients with AGC.

PMID:
42629231
Bibliographic data and abstract were imported from PubMed on 22 Aug 2026.

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