Atypical glandular cells of undetermined significance (AGUS): Cytopathologic features, histopathologic results, and human papillomavirus DNA detection

We intensively reviewed 137 smears initially classified as atypical glandul ar cells of undetermined significance (AGUS) to refine cytological criteria for evaluating these cases, evaluate histological outcomes, and assess the value of human papillomavirus (HPV) DNA testing in management. Consenting, nonpregnant study participants were identified from a cohort of 46,009 wom en receiving routine Pap smear screening in a managed care setting. Colposc opy was performed on all women, and at least one histological sample was ob tained from each. Review diagnoses were assigned to smears and biopsy speci mens by two separate panels of pathologists. DNA testing for cancer-associa ted HPV types was performed on rinses of cytological samplers after a smear and thin-layer slide had been made. On review, 47 (34%) smears were reclas sified as negative, 44 (32%) as AGUS, 30 (22%) as atypical squamous cells o f undetermined significance (ASCUS), and 16 (12%) as squamous intraepitheli al lesions (SIL). The 19 smears interpreted as high-grade intraepithelial l esions on review included 13 high-grade SIL (HSIL), two HSIL with AGUS, fav or neoplastic (endocervical adenocarcinoma in situ [AIS]), and four AGUS, f avor neoplastic (AIS). Review histological diagnoses were negative in 105 ( 77%), squamous or glandular atypia in four (3%), low-grade SIL (LSIL) in ni ne (7%), HSIL in 12 (9%),AIS in five (4%, including two with concurrent HSI L), and endometrial carcinoma in one (1%). HPV testing identified 11 (92%) of 12 women with histologically confirmed HSIL and all five with AIS (100%) . A high-grade intraepithelial lesion or carcinoma is detected in approxima tely 14% of women with community-based diagnoses of AGUS who are referred f or immediate evaluation. Use of refined cytological criteria and HPV DNA te sting may permit improved management of women with AGUS. Copyright (C) 1999 by W.B. Saunders Company.