Clinical Analysis of Atypical Glandular Cells of Undetermined Significance (AGUS) on Pap Smear according to Menopausal Status

Seok, Won Ik; Lee, Kwang Byum; Lee, Jong Min; Nam, Um Gi; Yoon, Seong Jun; Choi, Soo Lan; Kim, Seok Young; Kim, Kwang Jun; Lee, Jee Seong; Lee, Soon Pyo; Park, Chan Yong; Choi, Yoo Deok; Lee, Eui Don

Abstract

OBJECTIVE
To evaluate the clinical significance of AGUS including histologic results and diagnostic modalities according to menopausal status.
METHODS
One hundred and four patients with AGUS were identified. Corresponding biopsies were available for 87 of these cases. The evaluation for histologic results and diagnostic modalities was made according to menopausal status.
RESULTS
Among the 87 patients with AGUS, the number of premenopausal and menopausal patients were 46 (52.9%) and 41 (47.1%), respectively. Over all, 70 (80.5%) of 87 patients were found to have important histologic findings and of them, premenopausal and menopausal patients with invasive diseases were 19 (41.3%) and 31 (75.6%) respectively. There were significant differences in pathologic findings between premenopausal and menopausal patients indicating more invasive lesions in menopausal than premenopausal patients (p=0.002). For the evaluation of diagnostic modality, the second arm was significantly more needed for menopausal than premenopausal patients (p=0.018).
CONCLUSION
AGUS on pap smear represents a cytologic diagnosis associated with high incidence of underlying preinvasive and invasive lesions, especially in postmenopausal patients. Thus aggressive work-up is recommended to rule out the potential pathologic conditions in endocervix, endometrium and rarely extrauterine lesions such as gastrointestinal, tubal, ovarian or breast in patients otherwise unexplained AGUS after careful first arm work-up.