The clinical importance of atypical glandular cells of undetermined significance on the cytologic smear

Abstract

The objective of the study was to assess the prevalence of underlying cervical and endometrial lesions among patients with atypical glandular cells of undetermined significance (AGCUS) on the cytologic smear. Eighty-six patients with AGCUS, without evidence of squamous intraepithelial lesions, underwent coloposcopy and endocervical curettage (ECC) within 6 months of the initial finding. Endometrial samplings were performed in 25 patients. Coloposcopy, endocervical curettage, and endometrial biopsy results were reviewed. A significant lesion was defined as cervical intraepithelial neoplasia and/or any structural or histologic abnormality of the cervix or uterus (i.e., polyp). Statistical analyses were performed using the t test, chi-square, and Fisher’s Exact tests comparing patients with underlying lesions to those without. A significant lesion(s) was identified in 21 (24.4%) patients, with 8 (9.3%) of the lesions being high-grade cervical neoplasias. An additional 14 (16.3%) patients, with negative initial work-ups, had underlying lesions or major cytologic abnormalities diagnosed on subsequent follow-up. All of the endometrial findings were benign. None of the following were statistically significant predictors of underlying pathology: age, gravidy, parity, medications, medical history, tobacco use, history of sexually transmitted diseases including human immunodeficiency virus, previous abnormal cytologic smear, concurrent diagnosis of atypical squamous cells of undetermined significance, or evidence of human papillomavirus. AGCUS is often associated with clinically important underlying lesions. Patients should therefore undergo colposcopy and ECC. Endometrial sampling and possible cervical conization should be performed when coloposcopic evaluation is nondiagnostic.