Atypical Glandular Cells of Undetermined Significance: Significance of Cell Type and Age on Patient Management

Abstract

To compare the rate, accuracy, and histological correlation of cytological smears reported as atypical glandular cells of undetermined significance (AGUS) in different age groups. Cervical cytology smears reported as AGUS were reviewed and correlated with histologic follow-up and repeat cytology. A total of 40,464 Pap smears were performed at Long Island Jewish Medical Center between 1996 and 2000. Of those, 163 (0.4%) smears were diagnosed as AGUS, and 62% of the patients with AGUS had either histologic or cytologic follow-up or both. The highest AGUS rates occurred in the fifth (0.6%) and ninth (0.84%) decades of life. Eighty-eight patients had histologic follow-up. Significant endometrial lesions occurred in 15 patients. The mean age was 64 years. Significant cervical lesions occurred in 12 patients. The mean age was 45 years. Among women with AGUS-favor endometrial (AGFEM) cell origin, 9 of 34 women had a significant lesion (8 endometrial and 1 cervical). Four of 12 endometrial carcinomas were identified among women whose cytology suggested cervical origin. Older women were more likely to have significant endometrial lesions and younger women significant cervical lesions. However, neither cytologic criteria nor the patient's age is perfect in directing the clinician toward the likely origin of the atypical cells.