Results of the Clinical Evaluation of Atypical Glandular Cells of Undetermined Significance (AGCUS) Detected on Cervical Cytology Screening

Abstract

Objective: To determine the clinical significance of and underlying pathology among patients with atypical glandular cells of undetermined significance (AGCUS) identified on cervical Pap smear screening. Methods: The computerized files of the Cleveland Clinic Foundation cytology laboratory were searched from 1990 to 1994 to identify all patients with AGCUS. Patients with other significant cytologic diagnoses were considered separately from patients whose only significant finding was reported to be AGCUS. Retrospective chart review was completed to identify associated conditions and to record the results of the clinical evaluations of these patients. Results: One hundred thirty-six patients were identified among the 68,368 (0.2%) specimens from this 5-year period in contrast to 3078 (4.5%) patients with atypical squamous cells (ASCUS). Mean patient age was 43.7 years (range 20–78). Among 77 patients without other significant cytologic findings in addition to AGCUS, without prior gynecologic cancer and who had a recorded gynecologic evaluation, 13 patients (17%) were diagnosed with the following lesions: two (3%) invasive cervical adenocarcinomas, three cervical adenocarcinomasin situ(4%), three grade 1 cervical intraepithelial neoplasms (CIN) (4%), four grade 2–3 CIN (5%), and one (1%) endometrial adenocarcinoma. Additionally, in subsequent follow-up examinations two patients were diagnosed with cervical adenocarcinomain situ,one with invasive adenocarcinoma of the cervix and one with diffusely metastatic pancreatic cancer. Conclusions: AGCUS on cervical cytologic screening, even in the absence of other associated cytologic findings, is associated with substantial underlying uterine pathology including at least 4% (95% confidence interval (CI) 0.8%, 11.0%) invasive cancers and 13% (95% CI 6.4%, 22.6%) precancerous lesions. Cervical colposcopy, endocervical curettage, and endometrial biopsy are recommended for the complete evaluation of AGCUS.