Atypical glandular cells of undetermined significance - Clinically significant lesions and means of patient follow-up

BACKGROUND. The clinical significance of atypical glandular cells of undete rmined significance (AGUS) remains poorly understood, and patient managemen t is not standardized. The authors evaluated the rate, qualification, and f ollow-up (FU) findings of AGUS patients. METHODS. Computerized records from the authors' institution were searched f rom April 1992 to December 1997 for diagnoses of AGUS. Results of cytologic and histologic FU were evaluated up to 48 months of FU. Clinically signifi cant lesions were defined as squamous intraepithelial lesion (SIL), endomet rial pathology of hyperplasia or higher, adenocarcinoma in situ (AIS), or i nvasive adenocarcinoma. RESULTS. AGUS was diagnosed in 92 of 87,632 patients (0.11%). FU data were available from 69 patients, consisting of smears and/or surgical pathology specimens from the cenix, endometrium, or ovary. Forty patients had FU smea rs only, 13 had histologic FU only, and 16 had both. Seventeen patients (25 %; 15 patients with unqualified AGUS and 2 patients with "favor endometrial origin" according to the Bethesda System of AGUS subclassification) had cl inically significant lesions: high grade SIL (n = 8 patients), low grade SI L (n = 2 patients), endometrial lesion (n = 5 patients), AIS (n = 1 patient ), and invasive cervical adenocarcinoma (n = 1 patient). It is noteworthy t hat 4 patients with carcinoma (3 patients with AIS and 1 patient with invas ive carcinoma) were diagnosed after a long FU (36-48 months). The remaining 13 lesions were detected at first FU (1-24 months). Six lesions were detec ted on FU smear, whereas 15 were detected histologically (4 lesions were de tected in both). CONCLUSIONS. AGUS is associated with clinically significant lesions in 25% of patients who are followed. Most of the lesions were high grade and were detected histologically. Moreover, 4 of 17 lesions were detected after a FU period ranging from 36 months to 48 months. The role of qualifying AGUS ne eds further study. Cancer (Cancer Cytopathol) 2000;90:207-14. (C) 2000 Amer ican Cancer Society.