Atypical glandular cells of undetermined significance

Abstract

The clinical significance of atypical glandular cells of undetermined significance (AGUS) remains poorly understood, and patient management is not standardized. The authors evaluated the rate, qualification, and follow-up (FU) findings of AGUS patients. Computerized records from the authors' institution were searched from April 1992 to December 1997 for diagnoses of AGUS. Results of cytologic and histologic FU were evaluated up to 48 months of FU. Clinically significant lesions were defined as squamous intraepithelial lesion (SIL), endometrial pathology of hyperplasia or higher, adenocarcinoma in situ (AIS), or invasive adenocarcinoma. AGUS was diagnosed in 92 of 87,632 patients (0.11%). FU data were available from 69 patients, consisting of smears and/or surgical pathology specimens from the cervix, endometrium, or ovary. Forty patients had FU smears only, 13 had histologic FU only, and 16 had both. Seventeen patients (25%; 15 patients with unqualified AGUS and 2 patients with "favor endometrial origin" according to the Bethesda System of AGUS subclassification) had clinically significant lesions: high grade SIL (n = 8 patients), low grade SIL (n = 2 patients), endometrial lesion (n = 5 patients), AIS (n = 1 patient), and invasive cervical adenocarcinoma (n = 1 patient). It is noteworthy that 4 patients with carcinoma (3 patients with AIS and 1 patient with invasive carcinoma) were diagnosed after a long FU (36-48 months). The remaining 13 lesions were detected at first FU (1-24 months). Six lesions were detected on FU smear, whereas 15 were detected histologically (4 lesions were detected in both). AGUS is associated with clinically significant lesions in 25% of patients who are followed. Most of the lesions were high grade and were detected histologically. Moreover, 4 of 17 lesions were detected after a FU period ranging from 36 months to 48 months. The role of qualifying AGUS needs further study. Cancer (Cancer Cytopathol)