Atypical glandular cells of undetermined significance: the experience at long island jewish medical center

Our aim was to determine the rate, accuracy and histological correlates of cytological smears re-ported as atypical glandular cells of undetermined significance (AGUS). Cervical cytological smears reported as AGUS from January 1991 to December 1995 were reviewed and correlated with subsequent biopsies and Papanicolaou (Pap) smears. The AGUS rate was 0.53% (n = 114 of 21,468). Sixty-nine of the 114 cases (61%) had corresponding tissue specimens (biopsies and curettage), and 24 (21%) cases had subsequent Pap smears. No follow-up was available in 17 cases (15%). Four AGUS diagnoses represented recurrent high-grade squamous intraepithelial lesions. These lesions did not have biopsy confirmation but were treated on the basis of the Pap smear and colposcopic findings. Twenty-seven (23.6%) cases represented premalignant or malignant lesions, with a mean age of 52 years. Those patients with endometrial pathology had a mean age of 63 years, and those with squamous neoplastic lesions had a mean age of 39 years. Findings included 12 endometrial lesions (5 hyperplasias and 7 carcinomas); 2 adenocarcinomas in situ; 11 squamous lesions (10 squamous intraepithelial lesions and 1 squamous carcinoma); and 2 lesions with concomitant glandular and squamous abnormalities. Eleven of the 12 cases re-ported as AGUS-favor endometrial cells and 7 of the 12 cases reported as AGUS-favor neoplastic (AGFN) showed significant pathology. One screening error and 10 interpretive errors occurred (6 overcalled, 4 undercalled); however, no adverse out-comes were reported. AGUS-favor endometrial cells usually occur in older patients and almost always is associated with premalignant or malignant lesions. Endometrial curettage should be performed on these patients. AGFN often indicates a significant lesion, usually occurs in younger patients, and colposcopically directed biopsy or endocervical curettage should be performed. AGUS-favor reactive and AGUS unspecified are less likely to represent significant lesions, and a conservative clinical approach (interval Pap smears) may be appropriate.