Atypical glandular cells of undetermined significance (AGUS): Cytopathologic features, histopathologic results, and human papillomavirus DNA detection

• Published in: Human pathology Vol. 30; no. 7; pp. 816 - 825
• Main Authors: Ronnett, Brigitte M, Manos, M.Michele, Ransley, Janice E, Fetterman, Barbara J, Kinney, Walter K, Hurley, Leo B, Ngai, Jen Shieh, Kurman, Robert J, Sherman, Mark E
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.1999; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; AGUS; atypical glandular cells of undetermined significance; Biological and medical sciences; cervix; cytology; Diagnosis, Differential; DNA, Viral - analysis; Female; Genital system. Mammary gland; human papillomavirus; Humans; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Middle Aged; Pap smear; Papanicolaou Test; Papillomaviridae - isolation & purification; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Sensitivity and Specificity; The Bethesda System; Uterine Cervical Diseases - diagnosis; Uterine Cervical Diseases - pathology; Uterine Cervical Diseases - virology; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - virology; Vaginal Smears; atypical glandular cells of undetermined significance; cervix; cytology; CI; The Bethesda System; LSIL; Pap smear; AIS; HPV; HSIL; ASCUS; human papillomavirus; AGUS; Adenocarcinoma; Human; Glandular cell; Premalignant lesion; Cervical smear; Papovaviridae; Malignant tumor; Female genital diseases; Papillomavirus; Virus; Pathology; Human papillomavirus; Cervical dysplasia; Biopsy; Endocervix; Cytopathology; Female; Atypical; Diagnosis; Molecular biology; Uterine cervix diseases
• ISSN: 0046-8177; 1532-8392
• DOI: 10.1016/S0046-8177(99)90143-0

We intensively reviewed 137 smears initially classified as atypical glandular cells of undetermined significance (AGUS) to refine cytological criteria for evaluating these cases, evaluate histological outcomes, and assess the value of human papillomavirus (HPV) DNA testing in management. Consenting, nonpregnant study participants were identified from a cohort of 46,009 women receiving routine Pap smear screening in a managed care setting. Colposcopy was performed on all women, and at least one histological sample was obtained from each. Review diagnoses were assigned to smears and biopsy specimens by two separate panels of pathologists. DNA testing for cancer-associated HPV types was performed on rinses of cytological samplers after a smear and thin-layer slide had been made. On review, 47 (34%) smears were reclassified as negative, 44 (32%) as AGUS, 30 (22%) as atypical squamous cells of undetermined significance (ASCUS), and 16 (12%) as squamous intraepithelial lesions (SIL). The 19 smears interpreted as high-grade intraepithelial lesions on review included 13 high-grade SIL (HSIL), two HSIL with AGUS, favor neoplastic (endocervical adenocarcinoma in situ [AIS]), and four AGUS, favor neoplastic (AIS). Review histological diagnoses were negative in 105 (77%), squamous or glandular atypia in four (3%), low-grade SIL (LSIL) in nine (7%), HSIL in 12 (9%), AIS in five (4%, including two with concurrent HSIL), and endometrial carcinoma in one (1%). HPV testing identified 11 (92%) of 12 women with histologically confirmed HSIL and all five with AIS (100%). A high-grade intraepithelial lesion or carcinoma is detected in approximately 14% of women with community-based diagnoses of AGUS who are referred for immediate evaluation. Use of refined cytological criteria and HPV DNA testing may permit improved management of women with AGUS.