Atypical Glandular Cells of Undetermined Significance in Cervical Cytologic Findings

Abstract

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)

Clinical implications of atypical glandular cells of undetermined significance, favor endometrial origin

“…Most laboratories report an AGUS rate Ͻ 1%. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] The AGUS rate of 0.56% observed among the general patient population in our laboratory was in agreement with the current literature. Few studies have investigated the incidence of atypical endometrial cells in cervicovaginal smears.…”

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Little is known about the clinical significance of AGUS, favor endometrial origin (AGUS-EM). In this retrospective study, we determined the rate of a diagnosis of AGUS-EM and the incidence of clinically significant lesions in women with this cytologic diagnosis on subsequent follow-up.…”

Clinical Significance of Atypical Glandular Cells by the 2001 Bethesda System in Cytohistologic Correlation

“…The significance and clinical impact of the atypical glandular Pap smear has been studied using histologic correlation and described in many previous reports, with significant pathology findings ranging from 8.2% to 53%. [4][5][6][7][8][9][10] The primary goal of this study was to evaluate the pathology outcome of AGC diagnosed by the 2001 Bethesda System criteria and compare the results between the subclassifications of "NOS" and "favor neoplasia" and "cell type of origin" to tailor the management protocols suggested by the 2001 Consensus Guidelines for the management of women with cervical cytologic abnormalities by the American Society for Colposcopy and Cervical Pathology (ASCCP). 11 The other aim of the study was to determine whether there would be any morphologic observations highly suggestive of significant pathology to increase the sensitivity of the interpretation of Pap smears.…”

“…pathology, with the incidence raging from 8.2% to 53%. [4][5][6][7][8][9][10] Most studies defined significant pathology as precursor lesions (including squamous intraepithelial lesions [high and/or low], endocervical AIS, endometrial hyperplasia and endocervical glandular dysplasia) and invasive diseases (both gynecologic tract and nongynecologic systems). In our study, low-grade intraepithelial lesions and endometrial polyps were categorized in the benign group, representing insignificant pathology results, and we found a higher rate of abnormal pathology (42%) using 2001 Bethesda System criteria compared with using 1988 Bethesda (approaching 25%).…”

“…This result was similar to those of several previous reports. [4][5][6][7] In Gurbuz's study, 12 AGUS Pap smears were reclassified according to 2001 Bethesda criteria, with the findings that the difference between the rates of malignant pathologic conditions in the AGUS (19 of 76 [25%]) and in the AGC (18 of 42 [42.8%]) categories was significant. These findings proved 2001 Bethesda System criteria to be more specific than those of the previous system because of increased knowledge and understanding of glandular cytology.…”