Incidence and evaluation of an AGUS Papanicolaou smear in primary care

The category atypical glandular cells of undetermined significance (AGUS) occurs in about 0.5% of Papanicolaou smears. Although recent case series report a great many dysplastic, cancerous, and precancerous lesions of the cervix and endometrium associated with AGUS, little attention has been focused on this issue in primary care literature.

We report a case series of 52 women with AGUS Papanicolaou smears in a family health center during 2 years (1997 to 1998), along with colposcopy and biopsy results and 18 months of follow-up findings. These results were compared with findings of recent reports.

The incidence of AGUS was 0.5%, 52 of 10,564 Papanicolaou smears. Colposcopy was performed in 45. Biopsy (n = 46) showed 2 adenocarcinomas of the endometrium, and 6 high-grade dysplastic lesions, including 1 squamous cell carcinoma in situ. Nineteen women had cervical intraepithelial neoplasia stage I-changes of human papillomavirus effect, and 4 had endocervical polyps. Three women were lost to follow-up. The frequency of dysplastic and cancerous lesions in our population (17.4%) is consistent with series findings from cytology and obstetrics and gynecology literature, reporting that 19.5% of women with AGUS have either cancer--adenocarcinoma of the endometrium, squamous cell carcinoma, or extrauterine (8%)--or high-grade lesions--cervical intraepithelial neoplasia II-III, carcinoma in situ, or cervical adenocarcinoma in situ, (11.5%).

A relatively large percentage of women with AGUS on Papanicolaou smears have cancerous and dysplastic squamous and glandular lesions of the exocervix, endocervix, and endometrium. Clinical practice guidelines recommend patients with AGUS should be evaluated with colposcopy and endocervical curettage. Consensus supports endometrial sampling in women 35 years and older and in those with a laboratory report of AGUS, favors neoplasia or suggests an endometrial source.