Clinical Evaluation of Follow-Up Methods and Results of Atypical Glandular Cells of Undetermined Significance (AGUS) on Cervicovaginal Pap Smears

Kim, Tae Jin; Lim, Kyung Taek; Chung, Hwan Wook; Lee, Ki Heon; Lee, Seung Ho; Park, In Sou; Park, Chong Taik; Shim, Jae Uk

Abstract

OBJECTIVE
To evaluate the efficacy of the follow up methods and results of AGUS detected on cervicovaginal Pap smears.
METHODS
From May 1991 to December 1996, we have performed 407,451 cervicovaginal Pap smears, of which 326 patients were identified as AGUS. Out of them, 268 patients were followed by repeated Pap smears, colposcopy, cone biopsy or endometrial curettage.
RESULTS
The incidence of AGUS on Pap smears is approximately 0.08%. The mean patient age was 43 years (range 22~79 years). The most common complaint was abnormal vaginal bleeding. The gross findings of the cervix were normal or mild erosion. The past histories of patients that could effect the AGUS results on Pap smears were as follows: 30 had cone biopsy, 21 had Pap smear on pregnancy or within 8 weeks after delivery, 3 had hormone replacement therapy, 2 had intrauterine device for contraception, and 5 were in the process of a follow up after a treatment of cervical cancer. The benign lesions detected during follow up periods were 6 microglandular hyperplasia of the cervix, 5 atypical squamous metaplasia of the cervix, 2 cervical endometriosis, 2 tubal metaplasia, 10 cervical myoma, 11 cervical polyp, 9 endometrial polyp, 3 uterine myoma, 1 pelvic endometriosis, 1 ovarian endometriosis, and 4 uterine adenomyosis. The premalignant or malignant lesions of the cervix were 4 low grade squamous intraepithelial lesion, 24 high grade squamous intraepithelial lesion, 8 glandular atypia/dysplasia, 5 adenocarcinoma in situ, 3 microinvasive denocarcinoma, and 4 invasive adenocarcinoma. The neoplastic lesions of the uterus were 6 endometrial hyperplasia, 11 endometrial adenocarcinoma, 1 malignant mixed M?lerian tumor, and 1 metastatic endometrial adenocarcinoma. Sixty seven (25%) among 268 patients followed up were identified to have clinically significant lesions of the cervix or uterus. The detection rates of abnormal lesions were 3.1% with repeated Pap smears (3/98), 28.4% with colposcopy-directed biopsy (31/109), 63.6% with cone biopsy (35/55), and 29.7% with endometrial curettage (19/64).
CONCLUSION
AGUS on Pap smears showed various benign and malignant lesions of the cervix or uterus. The clinicians must communicate with the pathologists regarding the clinical informations of the patient as well as the origin of atypical glandular cells in Pap smears. We recommend that the patients with AGUS on Pap smear should undergo immediate intensive diagnostic studies, including colposcopy with endocervical curettage or cone biopsy in order to detect the lesion of the cervix and endometrial curettage in order to detect the endometrial lesions.