ATYPICAL GLANDULAR CELLS OF UNDETERMINED SIGNIFICANCE - DIAGNOSTIC-ACCURACY AND INTEROBSERVER VARIABILITY USING SELECT CYTOLOGIC CRITERIA

Histologic follow-up of patients with the Bethesda system cervical-vag inal diagnosis of atypical glandular cells of undetermined significanc e (AGUS), ''favor endocervical origin'', or ''not otherwise specified' ' (NOS) shows a high percentage of clinically significant (neoplastic or preneoplastic) lesions. Using the criteria of atypical single cells , irregular nuclear membranes, and decreased cytoplasm, eight observer s retrospectively reclassified 88 AGUS, ''favor endocervical'', or NOS smears using a probabilistic scheme. Follow-up showed 46 clinically s ignificant and 42 benign lesions. The mean accuracy for all observers and the experienced observers was 65% and 72%, respectively. For the e xperienced observers, the mean specificity of a ''favor clinically sig nificant'' category was 72%; the mean sensitivity of a ''favor benign' ' category was 90%. For the less experienced observers, subclassificat ion had poor predictive value. We conclude that experienced observers may use specific criteria to correctly subclassify AGUS lesions, and t his may aid in patient management.