CLINICAL-EVALUATION OF ATYPICAL GLANDULAR CELLS OF UNDETERMINED SIGNIFICANCE ON CERVICAL CYTOLOGY

Objective: To determine the incidence of and identify risk factors for clinically significant diagnoses associated with the diagnosis on Pap anicolaou test of atypical glandular cells of undetermined significanc e. Methods: A computer search was initiated of diagnoses of atypical g landular cells of undetermined significance at the Massachusetts Gener al Hospital from January 1993 through December 1996. Seventy-three pat ients with 81 smears were identified that were seen in the Colposcopy Clinic. All cytology was reviewed. A clinically significant lesion was defined as high-grade squamous intraepithelial lesion (SIL) or worse, endocervical glandular atypia or worse, or carcinoma. Results: The ra te of diagnoses of atypical glandular cells of undetermined significan ce was 0.167%. All patients underwent colposcopy, and 88% underwent en docervical curettage. A clinically significant diagnosis was made in 3 4.2% of patients, including cancer in 8.2%. A concurrent squamous diag nosis carried a risk of clinically significant lesion of 50%, compared with a risk of 25.5% for atypical glandular cells of undetermined sig nificance alone (P =.043). Premenopausal and postmenopausal patients w ere both at risk for clinically important lesions, but premenopausal p atients were more likely to have a high-grade SIL (30.4% versus 7.4%, P =.04). The subtype ''suggestive of reactive'' was a significant nega tive predictor of significant lesion (odds ratio = 0.09, 95% confidenc e interval 0.018, 0.482) in a logistic regression model controlling fo r age, menopausal status, and concurrent squamous diagnosis. Conclusio n: Atypical glandular cells of undetermined significance is an importa nt Papanicolaou lest diagnosis that needs appropriate and careful eval uation. Further studies are required to clarify areas of risk and to m ake triage algorithms. (C) 1998 by The American College of Obstetricia ns and Gynecologists.).