Glandular Cells Of Undetermined Significance Research Articles

Atypical Glandular Cells of Undetermined Significance: Outcome Predictions Based on Human Papillomavirus Testing

Cases of atypical glandular cells (AGC) diagnosed on liquid-based preparations were culled from a 3-year period. When available, residual cellular material was analyzed for human papillomavirus (HPV) by polymerase chain reaction and correlated with cytologic and histologic (biopsy) outcome. Of 178,994 cytologic cases, 187 (0.1045%) contained AGC compared with 8,740 (4.8828%) atypical squamous cells (ASC) for an AGC/ASC ratio of 0.021. HPV results and follow-up were available for 108 specimens from 106 patients. Depending on the end-point (histologic/cyto-logic), the sensitivity range of HPV testing for significant cervical disease (high-grade squamous intraepithelial lesion [SIL], adenocarcinoma in situ [ACIS], invasive carcinoma) was 83% with a specificity range of 78% to 82%, a positive predictive value of 57% to 61%, and a negative predictive value of 91% to 95%. Fifteen false-positive results included concurrent ASC or low-grade SIL, ASC on follow-up cytology, and previous ACIS with a negative follow-up cone biopsy result. Noncervical glandular neoplasia (including atypical endometrial hyperplasia) was confirmed in 13 cases (1 recurrent), only 2 of which scored positive for HPV. HPV-positive AGC has a substantially higher positive predictive value for significant disease than ASC (61% vs historic 20%) and merits consideration in the triage of patients with atypical endocervical cells not otherwise specified. However, noncervical or other HPV-negative glandular neoplasia must be considered in all patients with AGC, particularly older patients.

Risk factors for squamous intraepithelial lesions (SIL) of the cervix among women residing at the US-Mexico border.

It is now well established that cervical cancer is caused by oncogenic human papillomavirus (HPV) infections that commonly infect women worldwide. What remains to be understood are the factors that contribute to cervical cancer in the presence of HPV infection. We conducted a case-control analysis of women recruited at the US-Mexico border to simultaneously evaluate factors associated with 3 cytologic outcomes: atypical squamous cells of undetermined significance or atypical glandular cells of undetermined significance (ASCUS/AGUS), low grade squamous intraepithelial lesions (LSIL) and high grade squamous intraepithelial lesions (HSIL). A cross-sectional binational study of 2059 women ages 15-79 years was conducted between 1997 and 1998. A significant difference in the distribution of cytologic categories by country was observed (3.0% vs. 0.7% HSIL among Mexican vs. US women, respectively). The only factors independently associated with all 3 cytologic outcomes were HPV infection and viral load. A linear increase in risk with increasing viral load was observed for each of the 3 outcome variables, with the strength of this association increasing with cytology abnormality. In addition to HPV infection, parity and Mexico as a country of residence appear to be associated with LSIL and HSIL, respectively. Factors associated with cytologic outcomes in analyses limited to women with HPV infection were similar to results obtained in models where HPV infection was included as a covariate. Future work is needed to evaluate the predictive value of HPV viral load utilizing more specific and quantitative measures.

Human resource requirements for introducing cervical screening--who do we need where?

While the data are not perfect it is the largest study published, and the proportion of women in each age group, age 30 years and above, is representative of the national South African population (with the exception of the 60+ age group where the study data are less, viz. 6.4% for the study as compared with 14.6% for the total South African population). While the site-specific samples are small, the aggregate data provide reasonable estimates of national prevalence. It is therefore realistic to generalise from these data to the South African population in order to provide data for planning purposes. What was done The published national prevalence survey provides age-specific rates for: squamous intraepithelial lesions, both low grade (LSIL) and high grade (HSIL); atypical squamous cells of undetermined significance (ASCUS); atypical glandular cells of undetermined significance (AGUS); and cytological invasive disease, both squamous and columnar. These age-specific national prevalence rates for the various diagnoses were applied to the age-specific census data 3 for each province (national age-specific rates multiplied by the total number of women per province in that age group for each diagnostic outcome category — table available on request). This calculation provides a likely estimate of the number of women in each province with normal, ASCUS, LSIL, HSIL, etc. Pap smear results. The prevalence survey found that 2% of Pap smears were unreadable using the Bethesda 4 classification and had to be repeated. Repeat Pap smears would also be required for women diagnosed with LSIL, ASCUS or AGUS. These data were used to calculate the number of women requiring first and repeat Pap smears per province (total number of smears required = total number of women per age group plus repeats required). The South African screening policy indicates that women should have Pap smears at least once every 10 years. Therefore the annual number of women requiring a Pap smear is the total number in the province divided by 10. To calculate a daily workload it was assumed that there are 200 working days per year.

A retrospective review on atypical glandular cells of undetermined significance (agus) using the Bethesda 2001 classification

Objectives The Bethesda system for reporting cervicovaginal cytologic diagnoses was recently revised in 2001. Pathologists are required to report not only whether the smear favors neoplastic changes, but also the origin of the abnormal cells. In this study, archival smears were reviewed to evaluate the usefulness of the new classification. Methods Smears having atypical glandular cells taken between January 1995 and December 1997 were reviewed and subclassified according to the revised Bethesda classification. Case records were then reviewed and cases with discrepancies between the cytological evaluation and corresponding final histological diagnoses were further reviewed. Results There were 138 smears reviewed. The mean age of the patients was 47 (range, 18 to 78). Thirty-four smears favored neoplasia and 104 favored “NOS” (“not otherwise specified”). Sixty smears favored endocervical origin and 78 endometrial origin. Forty-three patients (31%) had significant pathologies, including 12 (8.7%) patients with high-grade CIN, 2 (1.4%) with low-grade CIN, 5 (3.6%) with HPV infection, 7 (5.1%) with carcinoma of the corpus, 1 (0.7%) with cervical adenocarcinoma in situ, 4 (2.9%) with adenocarcinoma of the cervix, 3 (2.2%) with endometrial hyperplasia, and 5 (3.6%) with carcinoma of the ovary. Two (1.4%) patients had double primary female genital malignancies and 2 patients (1.4%) had extragenital malignancies. Significant correlation was found between smears “favor neoplasia” and a final diagnosis with significant pathology (χ 2 test, P < 0.05). Significant association was found between AGC favored endocervical origin and a final diagnosis with cervical diseases (χ 2 test, P < 0.05). Four of the 43 patients who had significant pathologies had lesions found during their subsequent visits and all of them had cervical smears classified as AGC “favor neoplasia”. Conclusions AGC found on cervical smears are an indication for early and intensive investigation.

Liquid-based cytology and conventional cervical smears: a comparison study in an Asian screening population.

This study compared the findings of cervical cytology screening by ThinPrep Papanicolaou (Pap) tests (TP) with the findings of screening by conventional cervical smears (CS) in a screening population involving what to the authors' knowledge is the largest sample of ThinPrep Pap tests published to date. Data from 191,581 CS that were screened in the period from March 1, 1998 to February 28, 2000 were compared with data from 190,667 TP performed from March 1, 2000 to February 28, 2002 and that were obtained from the same sources. With TP, the unsatisfactory rate was reduced from 0.48% to 0.32%. Fewer cases were considered to be suboptimal (19.12% vs. 12.97%). The detection rates of squamous cell carcinomas, adenocarcinomas, and high-grade squamous intraepithelial lesions (HSIL) were essentially unchanged in the TP group (0.005%, 0.003%, and 0.25%, respectively) compared with the rates for the CS group (0.01%, 0.006%, and 0.25%, respectively). There was an increase in the detection of atypical squamous cells of undetermined significance (ASCUS; 3.74% vs. 3.19%) and low-grade SIL (LSIL; 1.67% vs. 1.01%) with a decrease in the ASCUS-to-LSIL ratio from 3.15 for CS to 2.33 for TP. The detection of atypical glandular cells of undetermined significance (AGUS) increased slightly from 0.07% to 0.09%. The proportion of cells reported to have reactive atypia dropped from 2.71% to 1.48%. Limited biopsy correlation (range, 73.2-76.2%) confirmed the increased sensitivity of TP. More actinomyces (1.07% vs. 0.52%) were detected in TP samples despite of a similar portion of intrauterine-device users. The average primary screening and rapid rescreening time of each slide were reduced from 8 minutes to 4 minutes and from 2 minutes to less than 1 minute, respectively. The preliminary experience of the authors of the current study appears to support the use of the ThinPrep Pap test to enhance the efficiency of cervical cytology screening.

Participants at the ASCCP 2000 Biennial Meeting Adhere to Published Guidelines in Their Management of Atypical Squamous Cells and Atypical Glandular Cells on Pap Test

To determine practice patterns of the American Society for Colposcopy and Cervical Pathology (ASCCP) 2000 Biennial Meeting participants for management of women with atypical squamous cells of undetermined significance (ASCUS) and atypical glandular cells of undetermined significance (AGUS). A three-page survey was developed to query participants about their standard practices for managing atypical squamous cells and atypical glandular cells on Pap tests; use of human papillomavirus testing; and use of vaginal estrogen cream in postmenopausal women before follow-up. There were 217 completed surveys (47.0% response rate). Responses of 194 qualified surveys are presented here. For women with first-time ASCUS (unqualified) and no previous history of cervical intraepithelial neoplasia (CIN), 16.4% of respondents would perform colposcopy. For ASCUS (favor squamous intraepithelial lesion [SIL]), a significantly higher percent, 74.9%, would proceed immediately to colposcopy (p < .001). For ASCUS (unqualified or favor SIL) in a woman with a previous history of CIN, 82.7% and 95.5% would perform colposcopy, respectively (p < .001). For a patient with AGUS, 97.5% would perform colposcopy (with or without endocervical curettage or endometrial biopsy). Human papillomavirus testing was seldom used in the management of ASCUS (10.4%) and AGUS (7.8%). Participants at the 2000 ASCCP Biennial Meeting made clear distinctions between ASCUS and AGUS in managing women with abnormalities on Pap, and management was consistent with guidelines published by the ASCCP, American College of Obstetricians and Gynecologists, and the National Cancer Institute.

Atypical glandular cells of undetermined significance (agus) which entity?

The aim of this study was to determine the incidence and evolution of the atypical glandular cells of undetermined significance (AGUS) without associated lesions identified on cervical Pap smear. Retrospective study concerning 33.923 cervicovaginal smears performed in the Cytopathology Department of the Coimbra University Hospital (H.U.C.) between January 1995 an December 1997. AGUS diagnosis, isolated or associated with other lesions, was made in 716 cases. Four hundred fourty-four of them were refered to patiens of the H.U.C. Ginecology Department. One hundred seventy-seven cases were classified as AGUS alone; 62 related to the Ginecology Department where follow-up was performed within a period from 3 to 36 months. This study concerns exclusively AGUS patients without associated lesions (N=62). Sixty two cases of isolated AGUS were studied; the incidence was 0,52% and the average age 44,7 ±11,7 [19-75] years old. Follow-up, performed between 3 and 36 months, revealed: isolated cervical smears (N=9), cervical smears and endocervical curettage (N=15), cervical smears with colposcopy and directed biopsy and/or endocervical curettage (N=11), cervical smears and colposcopy (N=19). Total histerectomy was performed in 8 cases by other reasons. Cervical smears were normal in 91,2 % of the cases (N=62). Histologic examination of surgical samples refering to total histerectomy, cervix biopsies was normal in 14 cases (38,9%), revealed cronic cervicitis in 14 cases, LSIL in 7 cases and endocervical polyps in one case. In spite of the reduced data of the study, the results point to no need to an agressive therapeutical approach at AGUS diagnosis in Pap smears.

Atypical glandular cells: new Bethesda Terminology and Management Guidelines.

Although Pap tests have enabled early detection of premalignant lesions, the introduction of new collecting devices has significantly improved the detection of lesions hidden in the endocervical canal, such as adenocarcinoma in situ (AIS). The term "atypical glandular cells of undetermined significance" (AGUS) was introduced at the 1988 Bethesda Conference and defined as morphologic changes in glandular cells beyond those that are suggestive of the benign reactive process, but insufficient for the diagnosis of adenocarcinoma in situ (AIS). In the new 2001 Bethesda System, the term has been eliminated and replaced with the term "atypical glandular cells" (AGC), with the following subclassifications: not otherwise specified (NOS), favor neoplasia, endocervical AIS, and adenocarcinoma. The risks of premalignant or malignant disease associated with the AGC favor neoplasia category are substantially higher than in the AGC NOS category (96% vs. 9-41%, respectively). Patients diagnosed with AGC NOS or AGC favor neoplasia will require colposcopy, endocervical sampling, and, for patients over 35 years of age, endometrial biopsy. If all of these tests are negative, the Pap test should be repeated in 4-6 month intervals until 4 consecutive normal tests are obtained. Positive results in one of the tests will require management according to ASCCP guidelines. The AGC favor neoplasia diagnosis also requires cervical conization and/or other testing, as the incidence of premalignant or malignant lesions in patients with this diagnosis is high. The role of HPV testing in this setting is unknown at this time.

Performance indicators of organized cervical screening in Romagna (Italy)

The availability of published data from organized cervical screening programmes in southern Europe is scant. In the Italian area of Romagna, a first round of organized screening (based on a 3-yearly Pap smear for women aged 25-64 years) was initiated between December 1995 and January 1997 and was completed in an average of 42 months (range 36-48 months). The target population included 305 478 women. Of these, 253 949 were eligible and received a personal letter of invitation. Age-specific screening performance indicators were calculated according to standard methods. The response rate within 6 months of invitation was 49.1% (n=124 621). The total participation rate including women who presented later was 61.7% (n=156 735). The recall rate was 35.2 per 1000 of participants (n=5514). Positive cytology results were distributed as follows: atypical squamous cells of un-determined significance/atypical glandular cells of undetermined significance (ASCUS/AGUS) 40.1%, low-grade squamous intraepithelial neoplasia (LGSIL) 48.6%, high-grade squamous intraepithelial neoplasia (HGSIL) 10.7% and carcinoma 0.7%. Compliance to colposcopy follow-up was 93.4% (n=5149). The biopsy rate was 52.4% (n=2696) of patients undergoing colposcopy. The detection rate was 4.5 per 1000 of participants (n=707) for CIN2-3 and 0.5 (n=75) for invasive carcinoma. The proportion of microinvasive carcinomas was 36.0% (n=27). The positive predictive value for CIN2-3/carcinoma was 5.8% for the cytology reports of ASCUS/AGUS, 7.6% for those of LGSIL, 76.5% for those of HGSIL, and 100.0% for those of carcinoma (80.4% for combined HGSIL/carcinoma). The ratio of observed to expected (or prevalent to incident) cases of invasive carcinoma was 2.35 (95% confidence interval (CI) 1.85-2.95). In conclusion, most early results of the programme were compatible with an acceptable performance.

Using History and Colposcopy to Select Women for Endocervical Curettage: Results From 2,287 Cases

In this study the authors conducted a retrospective review of the medical records of women who attended the dysplasia clinic at Cook County Hospital between July 1996, and December 1999 to investigate the frequency with which endocervical curettage (ECC) provides information that alters recommended treatment of cervical dysplasia. During this period 2825 patients had a colposcopic examination for evaluation of cervical abnormality. More than 80% of the women (N = 2287) underwent ECC at the time of colposcopy. In 209 patients the ECC specimen was unsatisfactory. The diagnosis was negative for disease in 1745 patients, dysplasia in 320 patients, and cancer in 13 patients. Compared with those with negative findings, women with a positive ECC specimen were three times more likely to have a diagnosis of cervical intraepithelial neoplasia grade 2 (CIN 2) or worse (P <.001) and nine times more likely to have a diagnosis of cancer (P <.001). For 105 of the 333 women with positive ECC specimens (105 of 2287, 4.6%), this diagnosis was the only indication for loop excision. Conization was done in 69 of these patients; 9 had no lesion, 8 had koilocytosis or squamous atypia, 2 had ungraded CIN, 17 had CIN 1, 3 had CIN 2, 17 had CIN 3, and 3 had cancer. Colposcopic examination in the three patients with cancer showed a benign lesion in two and a high-grade abnormality in one. In all, 33 (1.4%) who had no indication for loop excision except positive ECC were eventually diagnosed with CIN 2, CIN 3, or cancer. During the period of this study, loop excision or cone biopsy was recommended for all women with positive ECC, women with at least CIN 2 on colposcopic biopsy, women with an unsatisfactory colposcopic evaluation and cytology showing a low-grade squamous intraepithelial lesion, and those with cytologic evidence of cancer. In this series atypical squamous cells of unknown origin favoring dysplasia were found in 29 women of the 333 women with positive ECC results. These women are at low risk for serious disease, but adding this criterion to the indications for cone excision would have increased the percentage of patients whose treatment plan was altered by ECC. On the other hand, limiting the indications for cone biopsy to women with at least atypical glandular cells of undetermined significance or high-grade squamous intraepithelial lesion would have decreased the number of women whose treatment was changed by ECC. Also, if the patients with a colposcopic impression of CIN 2 or 3 were recommended for cone biopsy, the percentage of those whose treatment was changed by ECC results would have been lower. An analysis of possible characteristics associated with positive ECC results found higher age (P <.001), higher parity (P <.001), earlier age at first intercourse (P =.006), history of unsatisfactory colposcopy (P <.001), and history of colposcopic impression of CIN (P <.001) to be significant predictors of having a positive ECC result. However, in this series, using only these factors as indications for ECC would have missed several women with high-grade CIN or cancer. There would have been no missed cancers if ECC had been omitted in women with satisfactory colposcopy, a normal colposcopic impression, and/or nulliparity.

Atypical Glandular Cells of Undetermined Signi.cance

To verify the cytologic predictive value of a diagnosis of atypical glandular cells of undetermined significance (AGUS) in high grade squamous intraepithelial lesions (HSIL) cases. In a retrospective study, 98 cases of HSIL were reviewed. All patients were referred for colposcopy and directed biopsy to confirm the cytologic diagnoses. Loop excision of the transformation zone was performed to treat clinical lesions. Sensitivity, specificity, positive and negative predictive value were evaluated. Kappa statistics and logistic regression analysis were used to evaluate the findings statistically. By logistic regression analysis, we found that the chance of finding squamous intraepithelial lesions involving glands in AGUS smears was 5.32 times higher than in those with no AGUS. It was 5.74 times higher in cervical intraepithelial neoplasia (CIN) 3 lesions than in CIN 2. The cytologic predictive value for HSIL involving glands is statistically significant when specific and objective criteria are used for the AGUS diagnosis.

Accuracy and Reproducibility of Telecytology Diagnosis of Cervical Smears: A Tool for Quality Assurance Programs

We randomly selected 50 cervical smears (benign, 14; atypical squamous cells of undetermined significance [ASCUS], 5; low-grade squamous intraepithelial lesion [LSIL], 10; high-grade squamous intraepithelial lesion (HSIL), 12; squamous cell carcinoma, 6; adenocarcinoma, 3) and captured 1,181 digital images (518 MB) at a maximum resolution of 1,600 × 1,200 pixels and transmitted them by e-mail. Diagnosis of glass slides and digital images was done independently in a double-blind manner by 3 pathologists and 3 cytotechnologists, commencing with the diagnosis of digital images followed by diagnosis of glass slides 3 months later. The procedure was repeated after 3 months. Diagnoses were recorded as benign, ASCUS or atypical glandular cells of undetermined significance, LSIL, HSIL, squamous cell carcinoma or adenocarcinoma, and “inadequate for diagnosis.” Diagnostic accuracy and interobserver reproducibility were analyzed using an intraclass correlation coefficient (ICC), which revealed good interobserver agreement for the first (0.72) and second (0.64) glass slide diagnoses and the first (0.72) and second (0.60) digital image diagnoses. The kappa values for intraobserver variation between first and second glass slide diagnoses and first and second digital image diagnoses showed moderate to excellent agreement. Digital images are suitable substitutes for glass slides; telecytology can be used as an alternative method for the cytologic diagnosis of cervical smears, particularly in quality assurance programs.

Management of Atypical Glandular Cells of Undetermined Significance Pap Smears: A Reappraisal

OBJECTIVE.: To find appropriate management of patients with atypical glandular cells of undetermined significance (AGUS) Pap smears. MATERIALS AND METHODS.: The authors present their findings on patients with 606 AGUS Pap smears based on colposcopy, cervical biopsies, endocervical curettage, and endometrial biopsy. Twenty-one proposed management schemes by other authors are reviewed. RESULTS.: From 606 AGUS Pap smears, 69% had benign findings and 31% had neoplastic findings. Among 29 patients with endometrial pathology, only 4 patients (14%) were <40 years old. All proposed management schemes were uniform in the use of colposcopy but differed on the selective use of endometrial biopsy. CONCLUSION.: An AGUS Pap smear requires colposcopy. We suggest endometrial biopsy for women over 40 years old and for women younger than 40 years old who have a high risk for endometrial neoplasia. Better-defined cytologic criteria from cytologists are needed.

Atypical Glandular Cells of Undetermined Significance Histologic Findings and Proposed Management

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%).

The effect of vaginal speculum lubrication on the rate of unsatisfactory cervical cytology diagnosis

OBJECTIVE: Nonlubricated plastic specula can adhere to the vaginal introitus and cause discomfort with pelvic examination. We wanted to see if application of water-soluble gel lubricant to the plastic vaginal speculum would change the unsatisfactory cervical cytology diagnosis rate. METHODS: Five public health family planning clinic sites were randomized to either water-soluble gel or water only as lubricant during speculum examination for cervical cytology collection. The pathologists were unaware of the assignment of lubricant use. The cumulative rates of cervical cytology diagnoses were calculated for 6 months before, 6 months during, and 6 months after the intervention. RESULTS: From July 1998 through December 1999, 8534 Papanicolaou smears were collected, with 1440 using gel lubrication from January 1999 through June 1999. Rates of unsatisfactory smears for lubricant use clinics were 1.4% during use of lubricant and 1.4% without use (odds ratio [OR] 1.0; 95% confidence interval [CI] 0.6, 1.8). Rates of unsatisfactory smears for lubricant use versus nonlubricant use clinics during the gel intervention period were 1.4% versus 1.3% (OR 1.1; 95% CI 0.6, 2.0). There were no significant differences for the rates of atypical squamous cells of undetermined significance, low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion, or atypical glandular cells of undetermined significance within or between lubricant and nonlubricant clinics for each 6-month period. There were no cases of invasive cancer. CONCLUSION: The use of a small amount of water-soluble gel lubricant on the outer inferior blade of the plastic vaginal speculum does not change cervical cytology results in a young, reproductive-age population.

The Effect of Vaginal Speculum Lubrication on the Rate of Unsatisfactory Cervical Cytology Diagnosis

In Brief OBJECTIVE Nonlubricated plastic specula can adhere to the vaginal introitus and cause discomfort with pelvic examination. We wanted to see if application of water-soluble gel lubricant to the plastic vaginal speculum would change the unsatisfactory cervical cytology diagnosis rate. METHODS Five public health family planning clinic sites were randomized to either water-soluble gel or water only as lubricant during speculum examination for cervical cytology collection. The pathologists were unaware of the assignment of lubricant use. The cumulative rates of cervical cytology diagnoses were calculated for 6 months before, 6 months during, and 6 months after the intervention. RESULTS From July 1998 through December 1999, 8534 Papanicolaou smears were collected, with 1440 using gel lubrication from January 1999 through June 1999. Rates of unsatisfactory smears for lubricant use clinics were 1.4% during use of lubricant and 1.4% without use (odds ratio [OR] 1.0; 95% confidence interval [CI] 0.6, 1.8). Rates of unsatisfactory smears for lubricant use versus nonlubricant use clinics during the gel intervention period were 1.4% versus 1.3% (OR 1.1; 95% CI 0.6, 2.0). There were no significant differences for the rates of atypical squamous cells of undetermined significance, low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion, or atypical glandular cells of undetermined significance within or between lubricant and nonlubricant clinics for each 6-month period. There were no cases of invasive cancer. CONCLUSION The use of a small amount of water-soluble gel lubricant on the outer inferior blade of the plastic vaginal speculum does not change cervical cytology results in a young, reproductive-age population. The application of water-soluble lubricant to the outside of the inferior vaginal speculum blade did not change the rate of unsatisfactory cervical cytology diagnosis.

Conventional and liquid‐based cervicovaginal cytology: A comparison study with clinical and histologic follow‐up

Increased rates of squamous intraepithelial lesion (SIL) diagnosis with liquid-based cervicovaginal cytology (CVC) methods are well documented. This retrospective study compares the ability of the ThinPrep Pap Test (TP) and the conventional Pap smear (CP) to detect biopsy-proven SIL and to exclude nonneoplastic disease. All CVC reports from January 1999 through December 2000 from seven community Family Medicine clinics affiliated with the University of Nebraska were reviewed. For women with at least one CVC diagnosis of epithelial cell abnormality (ECA), follow-up histology, cytology, and clinical data were obtained. Statistical analysis was performed using the chi-square method. SIL was diagnosed in 166 of 3,286 patients by TP (5.1%) and in 169 of 4,872 patients by CP (3.5%) (P < 0.001); 32 of the TP diagnoses (1.0%) and 34 of the CP diagnoses (0.7%) were high-grade SIL (HSIL). Atypical squamous or glandular cells of undetermined significance (ASCUS/AGUS) was the most severe abnormality diagnosed by TP in 218 patients (6.6%) and by CP in 279 patients (5.7%). Follow-up histology data on CVC SIL diagnoses showed evidence of cervical intraepithelial neoplasia in 94 patients screened by TP (2.9%) and in 79 patients screened by CP (1.6%) (P < 0.001); the biopsy diagnoses were CIN 2 or CIN 3 in 34 patients in the TP group (1.0%) and in 28 patients in the CP group (0.6%) (P < 0.025). Follow-up of patients in whom the first ECA CVC diagnosis was ASCUS or AGUS disclosed a positive predictive value for CIN of 22.8% for TP ASCUS/AGUS diagnoses and 11.9% for CP ASCUS/AGUS diagnoses (P < 0.005). In this population, TP was significantly better than CP in detecting biopsy- proven disease and in screening out benign abnormalities.

Atypical glandular cells of undetermined significance from extramammary Paget’s of the bladder

BACKGROUND: The clinical significance and appropriate diagnostic evaluation of atypical glandular cells of undetermined significance (AGCUS) on cervicovaginal Papanicolaou test have not been well established. CASE: A 53-year-old woman with AGCUS underwent colposcopy, cervical biopsy, hysteroscopy, dilation and fractional curettage, and subsequently hysterectomy with bilateral salpingo-oophorectomy without abnormal findings. A repeat vaginal Papanicolaou test revealed malignant cells. Extramammary Paget’s disease and urothelial carcinoma in situ were subsequently determined to be the source of the abnormal cells interpreted as AGCUS. CONCLUSION: AGCUS may be associated with extramammary Paget’s disease and urothelial carcinoma. One should maintain a high index of suspicion for extragenital causes of persistent AGCUS.

Atypical Glandular Cells of Undetermined Significance From Extramammary Pagetʼs of the Bladder

Atypical Glandular Cells of Undetermined Significance From Extramammary Pagetʼs of the Bladder

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

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.