Atypical squamous and glandular cells of undetermined significance (ASCUS and AGUS) of the uterine cervix

ASCUS (Atypical Squamous Cells of Undetermined Significance) and AGUS (Atyp ical Glandular Cells of Undetermined Significance), or AGCUS, are two acron yms introduced in 1988 by The Bethesda System (TBS) for reporting borderlin e cytological changes in cervical cytology. ASCUS and AGUS categories shoul d be subclassified. Five ASCUS subgroups were proposed: 1) ASCUS due to pro cessing defects, 2) with "mature" cytoplasm, 3) in post-menopausal women (c l in the setting of atrophy and b - with estrogen stimulation), 4) atypical metaplasia, and 5) ASCUS with keratinized cytoplasm. AGUS subgroups may be subcategorized in endometrial or endocervical on the basis of origin. Endo cervical AGUS should be further qualified, but the analysis of atypical gla ndular cells may be really difficult and the conclusive diagnosis is freque ntly "AGUS not otherwise specified". The subclassification of ASCUS and AGU S is useful for an appropriate clinical management, but pertinent patient i nformation (such as age, date of last menstrual period, mechanical therapie s, tamoxifen therapy, and others) is needed to avoid an overdiagnosis and c onsequently an overtreatment. In fact various subgroups require different c linical management. Therefore, an effective communication between cytopatho logists and referring physicians is essential in the analysis of squamous a nd glandular atypias.