Clinical evaluation of follow-up methods and results of atypical glandularcells of undetermined significance (AGUS) detected on cervicovaginal pap smears

Objectives. The aim of this study was to evaluate the efficacy of the follo w-up methods and results of atypical glandular cells of undetermined signif icance (AGUS) detected on cervicovaginal Pap smears. Methods. From May 1991 to December 1996, we have performed 407, 451 cervico vaginal Pap smears, of which 326 patients were identified as AGUS. Of the 3 26 patients, 268 patients were followed by repeat Pap smears, colposcopy, c one biopsy, or endometrial curettage. Results. The incidence of AGUS on Pap smears is approximately 0.08%. The me an age of the patients was 43 years (range 22-79 years). The most common co mplaint was abnormal vaginal bleeding. The gross findings of the cervix wer e normal to mild erosion. The following past histories of patients could af fect the AGUS results on Pap smear: 30 had cone biopsy, 21 had Pap smears o n pregnancy and within 8 weeks after delivery or evacuation, 3 were on horm onal replacement therapy, 2 had intrauterine devices for contraception, and 5 were undergoing follow-up after treatment of cervical cancer. The benign lesions detected during follow-up periods were 6 microglandular hyperplasi a of the cervix, 5 atypical squamous metaplasia of the cervix, 2 cervical e ndometriosis, 2 tubal metaplasia, 10 cervical myoma, 11 cervical polyps, 9 endometrial polyps, 3 uterine myoma, 1 pelvic endometriosis, 1 ovarian endo metriosis, and 4 uterine adenomyosis. The premalignant or malignant lesions of the cervix were 4 low-grade squamous intraepithelial lesions, 24 high-g rade squamous intraepithelial lesions, 8 glandular atypia/dysplasia, 5 aden ocarcinoma in situ, 3 microinvasive adenocarcinoma, and 4 invasive adenocar cinoma. The neoplastic lesions of the uterus were 6 endometrial hyperplasia , 11 endometrial adenocarcinoma, 1 malignant mixed Mullerian tumor, and 1 m etastatic endometrial adenocarcinoma, Sixty-seven (25%) of 268 patients fol lowed up were identified as having clinically significant lesions of the ce rvix or uterus. The detection rates of abnormal lesions were 3.1% with repe ated Pap smears (3/98), 28.4% with colposcopic-directed biopsy (31/109), 63 .6% with cone biopsy (35/55), and 29.7% with endometrial curettage (19/64). Conclusion. AGUS on Pap smears showed various benign and malignant lesions of the cervix or uterus. The clinicians must communicate with the pathologi sts regarding the patient's clinical information as well as the origin of t he atypical glandular cells in Pap smears. We recommend that patients with AGUS on Pap smear should undergo immediate intensive diagnostic studies, in cluding colposcopic directed biopsy with endocervical curettage or cone bio psy, to detect cervical lesions and endometrial curettage to detect endomet rial lesions. (C) 1999 Academic Press.