Content area
Full Text
Atypical glandular cells on Papanicolaou smears are an unusual but important cytologic diagnosis. The Bethesda system classifies atypical glandular cells of undetermined significance (AGUS) as glandular cells that demonstrate nuclear atypia appearing to exceed reactive or reparative changes but lacking unequivocal features of adenocarcinoma. AGUS occurs in approximately 0.18 to 0.74 percent of all cervical smears. Because of the high likelihood that AGUS is associated with significant clinical disease, simply repeating the Papanicolaou smear is not sufficient for the management of AGUS. Unlike women with atypical squamous cells of undetermined significance, a significant percentage of women with AGUS will have more serious lesions, such as high-grade preinvasive squamous disease, adenocarcinoma in situ, adenocarcinoma or invasive cancers from sites other than the cervix. Colposcopic examination is recommended for all women with a cytologic diagnosis of AGUS. Those women with AGUS that is suspicious for adenocarcinoma should undergo cervical Ionization, even in the absence of detectable abnormalities on colposcopic examination. (Am Fam Physician 2001;63:2239-44.)
The evaluation and management of atypical glandular cells of undetermined significance (AGUS), which is diagnosed by Papanicolaou (Pap) smear, often prove to be perplexing and difficult for physicians. The diagnosis occurs relatively infrequently compared with other cytologic abnormalities. Strategies for the management of AGUS readings on Pap smears are often confused with those used for Pap smears that have been read as atypical squamous cells of undetermined significance (ASCUS). However, AGUS Pap smears are much more likely to be associated with more severe underlying abnormalities. Because of this, simply repeating the Pap smear, which is often done to manage ASCUS Pap smears, is not sufficient for managing patients who have potentially more serious AGUS readings. This review describes the epidemiology, classification and evaluation of AGUS cytologic smears and the management of patients with these readings.
Epidemiology
AGUS is a relatively uncommon cytologic diagnosis, occurring in approximately 0.18 to 0.74 percent of cervical smears.1 Of women with AGUS smears, 50 to 80 percent will have no histologic abnormality on further evaluation. However, 20 to 50 percent are found to have significant histologic abnormalities, such as cervical intraepithelial neoplasia, adenocarcinoma in situ (AIS) or adenocarcinoma.1
The incidence of cervical AIS and adenocarcinoma has been steadily increasing over the past 20 years. A significant increase...