August 23rd, 2019

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Clinical Significance of a Cytologic Diagnosis of Atypical Glandular Cells of Undetermined Significance
Authors:  Ru-fong Joanne Cheng, M.D., Enrique Hernandez, M.D., Lisa L. Anderson, M.D., Paul B. Heller, M.D., and Rachel Shank, R.N.
  OBJECTIVE: To assess the clinical significance of a cytologic diagnosis of
atypical glandular cells of undetermined significance (AGUS) and determine the
most appropriate evaluation of these patients.

STUDY DESIGN: Between 1993 and 1995, 44,217 Papanicolaou smears were evaluated
at Allegheny University Hospitals, Medical College of Pennsylvania Campus. There
were 108 (0.24%) cases of AGUS smears during that time. No clinical information
was available for 14 patients, and 19 were lost to follow-up. The charts of the
remaining 75 cases were retrospectively reviewed.

RESULTS: Tissue specimens were available for 62 of the 75 patients. There were
26 (42%) with no significant histopathologic findings, 13 (21%) with polyps, 5
(8%) cases of endometrial hyperplasia, 2 (3%) with endometrial adenocarcinoma,
12 (19%) with cervical intraepithelial neoplasia (CIN), 1 (2%) with
adenosquamous carcinoma of the cervix, 2 (3%) with cervical adenocarcinoma in
situ and 1 (2%) case of metastatic breast cancer. The total number of patients
with significant histopathology other than polyps was 23 (37%). The median age
of the patients was 49 years. There were more cases of endometrial hyperplasia
and endometrial cancer (19%) in women 49 years or older than in younger women;
only one (3%) case of endometrial hyperplasia was detected in the younger age
group (P=.057). Patients who underwent more-aggressive evaluation (colposcopy
and biopsies plus endometrial sampling, cone biopsy or hysterectomy) had greater
numbers of abnormal histopathologic findings (55%) than patients who underwent
endometrial sampling only (21%) or those who underwent colposcopy and biopsy
only (33%). This difference approaches statistical significance (P=.057). A
significant proportion of patients with a history of CIN and a cytologic
diagnosis of AGUS were found to have CIN (47%), while 8% of those with no
history of CIN were found to have CIN (P=.002). Fifty percent of patients with a
history of cancer (all had breast cancer) and AGUS had abnormal histopathology.
Patients with a subclassification of AGUS "favor neoplasia" had a greater
proportion of significant histopathology (72%) as compared to AGUS "unspecified"
(26%) and AGUS "favor reactive" (20%) (P=.003).

CONCLUSION: A significant proportion of women with a cytologic diagnosis of AGUS
have abnormal histopathology. Heightened awareness should be raised in patients
with AGUS and a history of CIN or cancer and in those with the AGUS
subclassification "favor neoplasia." (J Reprod Med 1999;44:922-928)
Keywords:  cervix neoplasms; cytology; Papanicolaou smear; atypical glandular cells of undetermined significance
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