RESULTS OF THE CLINICAL-EVALUATION OF ATYPICAL GLANDULAR CELLS OF UNDETERMINED SIGNIFICANCE (AGCUS) DETECTED ON CERVICAL CYTOLOGY SCREENING

Objective: To determine the clinical significance of and underlying pa thology among patients with atypical glandular cells of undetermined s ignificance (AGCUS) identified on cervical Pap smear screening. Method s: The computerized files of the Cleveland Clinic Foundation cytology laboratory were searched from 1990 to 1994 to identify all patients wi th AGCUS. Patients with other significant cytologic diagnoses were con sidered separately from patients whose only significant finding was re ported to be AGCUS, Retrospective chart review was completed to identi fy associated conditions and to record the results of the clinical eva luations of these patients. Results: One hundred thirty-six patients w ere identified among the 68,368 (0.2%) specimens from this 5-year peri od in contrast to 3078 (4.5%) patients with atypical squamous cells (A SCUS), Mean patient age was 43.7 years (range 20-78), Among 77 patient s without other significant cytologic findings in addition to AGCUS, w ithout prior gynecologic cancer and who had a recorded gynecologic eva luation, 13 patients (17%) were diagnosed with the following lesions: two (3%) invasive cervical adenocarcinomas, three cervical adenocarcin omas in situ (4%), three grade 1 cervical intraepithelial neoplasms (G IN) (4%), four grade 2-3 CIN (5%), and one (1%) endometrial adenocarci noma. Additionally, in subsequent follow-up examinations two patients were diagnosed with cervical adenocarcinoma in situ, one with invasive adenocarcinoma of the cervix and one with diffusely metastatic pancre atic cancer, Conclusions: AGCUS on cervical cytologic screening, even in the absence of other associated cytologic findings, is associated w ith 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, endocervica l curettage, and endometrial biopsy are recommended for the complete e valuation of AGCUS. (C) 1996 Academic Press, Inc.