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Clinical Significance of Atypical Glandular Cells on Cervical Cytology

Schnatz, Peter F. DO1,2; Guile, Matthew MD3; O'Sullivan, David M. PhD1; Sorosky, Joel I. MD1,2,4

doi: 10.1097/01.AOG.0000202401.29145.68

OBJECTIVE: To evaluate the prevalence and histologic outcomes of patients with atypical glandular cells of undetermined significance (AGUS), diagnosed by Pap test, and concurrent risk factors.

DATA SOURCES: A PubMed/MEDLINE/Ovid HealthStar search of the English literature was conducted from January 1988 through March 2004.

METHODS OF STUDY SELECTION: The search criteria included the terms “atypical glandular cells of undetermined significance,” “AGUS,” or “AGC.” All studies investigating the clinical significance of patients with an AGUS Pap test were included, except for those where consecutive Pap tests were not studied. Diagnostic outcomes were then determined.

TABULATION, INTEGRATION, AND RESULTS: Of the 916 studies identified, 24 met our inclusion criteria. Of the 2,389,206 Pap tests included in these studies, 6,829 (0.29%) had AGUS. Follow-up was available for 3,890 tests. These data showed the following rates of pathology: 8.5% low-grade squamous intraepithelial lesions (LSIL), 11.1% high-grade squamous intraepithelial lesions (HSIL), 2.9% adenocarcinoma in situ, 1.4% endometrial hyperplasia, and 5.2% malignancy. The most common malignancies were endometrial adenocarcinoma (57.6%), cervical adenocarcinoma (23.6%), ovarian and fallopian tube carcinoma (6.4%), squamous cell carcinoma of the cervix (5.4%), and other (6.9%). Of the AGUS Pap tests, the remaining 71.0% corresponded to benign findings, including reactive changes, polyps, and normal histology. Patients with AGUS, which favors a neoplastic process, or with a concurrent ASCUS have a greater likelihood of disease.

CONCLUSION: Histologic diagnosis showed that 29.0% of these Pap tests had findings requiring follow-up or therapeutic intervention, including a 5.2% rate of malignancy. Based on these findings, 99.6% of the diagnoses are within the region of surveillance when AGUS Pap tests are evaluated with colposcopy and directed biopsy, endocervical curettage, an endometrial biopsy in patients with risk factors for endometrial cancer, and pelvic examination.

Women with atypical glandular cells diagnosed by cervical cytology are at high risk for underlying pathology, and several markers put patients at more substantial risk.

From 1Hartford Hospital, Hartford, Connecticut; 2University of Connecticut, Farmington, Connecticut; 3Johns Hopkins Hospital, Baltimore, Maryland; and 4New Britain General Hospital, New Britain, Connecticut.

We thank Valori Banfi, MSLS, for her assitance with our literature search.

Presented at the 53rd Annual Meeting of The American College of Obstetricians and Gynecologists (ACOG), San Francisco, California, on May 9, 2005.

Corresponding author: Peter F. Schnatz, DO, Hartford Hospital, Conklin Building 203B, 80 Seymour Street, Hartford, CT 06102; e-mail:

© 2006 The American College of Obstetricians and Gynecologists