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Am J Obstet Gynecol 1999;180(4):883–8 To increase our understanding of the clinical significance of atypical glandular cells of undetermined origin, all Papanicolaou smears were reviewed and classified using the Bethesda System. Charts of all patients with a diagnosis of atypical glandular cells of undetermined origin were reviewed for previous medical history, diagnostic study, histologic diagnosis, and prior Papanicolaou smear abnormalities. The incidence of atypical glandular cells of undetermined origin in 76,018 Papanicolaou smears was 0.196%. We reviewed 133 patient medical records with cytologic diagnoses. Eighty of these patients have had appropriate follow‐up. Thirty‐six (45%) of these were found to have significant histologic abnormalities, including 6 patients with cervical intraepithelial neoplasia, grades 2 and 3, and 4 invasive cancers. The frequency of underlying serious histologic changes is much greater in atypical glandular cells than in atypical squamous cells of undetermined significance. On the basis of our results, we believe that all patients with atypical glandular cells should undergo intensive evaluation including colposcopy, cervical biopsy, and endocervical curettage. When diagnosis cannot be clearly established, patient should undergo endometrial biopsy. Editorial Comment: Manetta et al. reiterate in a retrospective review of Pap smears classified as atypical glandular cells of undetermined significance (AGUS), the significance of this smear and significant histological abnormalities. Cytologyl is a screening test. An AGUS Pap smear is a positive screen and the further evaluation must be done. In this group 45% of the patients had significant histological abnormalities, including 6 patients with CIN and 4 with invasive carcinoma. (LBT)

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