Atypical Glandular Cells of Undetermined Significance Histologic Findings and Proposed Management

Abstract

Atypical glandular cells of undetermined significance (AGUS) has been a poorly understood classification of abnormal cervical smears since its introduction in 1988 as part of the Bethesda System. To provide greater understanding of this diagnosis, this article presents the results of an analysis of data from the medical records of 189 patients with AGUS seen over a 5-year period from 1993 to 1998. These patients represent 0.1% of the total number of women who had cervical smears in this period. Ninety-three patients were excluded for various reasons, including hysterectomy, insufficient follow-up, and loss to follow-up, leaving 114 patients in the analysis. Their average age was 44 years, and one third were postmenopausal at the time of AGUS diagnosis. After review the Pap smear was subclassified as in 20 and in 23 with no further classification possible in the remaining 71 cases. Histologic findings are presented in Table 1. Five of the 20 patients in the favor reactive group were diagnosed with cervical intraepithelial neoplasia (CIN) 3, two with CIN 2, and one with adenocarcinoma carcinoma in situ of the cervix. In the favor neoplastic group, three patients had CIN 2 or 3, one had adenocarcinoma in situ, and seven were diagnosed with endometrial cancer. In this analysis the differences between the favor reactive and favor neoplastic group did not reach significance. Squamous cell lesions of the cervix were significantly more common among premenopausal than post menopausal women (32% vs. 3% dysplasia). Postmenopausal women were significantly more likely to have endometrial cancer (24% vs. 3%).