Atypical glandular cells of undetermined significance (AGUS)

Cytopathologic features, histopathologic results, and human papillomavirus DNA detection

Brigitte M. Ronnett, M. Michele Manos, Janice E. Ransley, Barbara J. Feherman, Walter K. Kinney, Leo B. Hurley, Jen Shieh Ngai, Robert J. Kurman, Mark E. Sherman

Research output: Contribution to journalArticle

144 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)816-825
Number of pages10
JournalHuman Pathology
Volume30
Issue number7
DOIs
StatePublished - 1999
Externally publishedYes

Fingerprint

DNA
Smear Layer
Papanicolaou Test
Colposcopy
Managed Care Programs
Endometrial Neoplasms
Carcinoma
Biopsy
Adenocarcinoma in Situ
Squamous Intraepithelial Lesions of the Cervix
Neoplasms

Keywords

  • AGUS
  • Atypical glandular cells of undetermined significance
  • Cervix
  • Cytology
  • Human papillomavirus
  • Pap smear
  • The Bethesda System

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Atypical glandular cells of undetermined significance (AGUS) : Cytopathologic features, histopathologic results, and human papillomavirus DNA detection. / Ronnett, Brigitte M.; Manos, M. Michele; Ransley, Janice E.; Feherman, Barbara J.; Kinney, Walter K.; Hurley, Leo B.; Ngai, Jen Shieh; Kurman, Robert J.; Sherman, Mark E.

In: Human Pathology, Vol. 30, No. 7, 1999, p. 816-825.

Research output: Contribution to journalArticle

Ronnett, Brigitte M. ; Manos, M. Michele ; Ransley, Janice E. ; Feherman, Barbara J. ; Kinney, Walter K. ; Hurley, Leo B. ; Ngai, Jen Shieh ; Kurman, Robert J. ; Sherman, Mark E. / Atypical glandular cells of undetermined significance (AGUS) : Cytopathologic features, histopathologic results, and human papillomavirus DNA detection. In: Human Pathology. 1999 ; Vol. 30, No. 7. pp. 816-825.
@article{7e63caf4548e4542af8310e89e6a197a,
title = "Atypical glandular cells of undetermined significance (AGUS): Cytopathologic features, histopathologic results, and human papillomavirus DNA detection",
abstract = "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.",
keywords = "AGUS, Atypical glandular cells of undetermined significance, Cervix, Cytology, Human papillomavirus, Pap smear, The Bethesda System",
author = "Ronnett, {Brigitte M.} and Manos, {M. Michele} and Ransley, {Janice E.} and Feherman, {Barbara J.} and Kinney, {Walter K.} and Hurley, {Leo B.} and Ngai, {Jen Shieh} and Kurman, {Robert J.} and Sherman, {Mark E.}",
year = "1999",
doi = "10.1016/S0046-8177(99)90143-0",
language = "English (US)",
volume = "30",
pages = "816--825",
journal = "Human Pathology",
issn = "0046-8177",
publisher = "W.B. Saunders Ltd",
number = "7",

}

TY - JOUR

T1 - Atypical glandular cells of undetermined significance (AGUS)

T2 - Cytopathologic features, histopathologic results, and human papillomavirus DNA detection

AU - Ronnett, Brigitte M.

AU - Manos, M. Michele

AU - Ransley, Janice E.

AU - Feherman, Barbara J.

AU - Kinney, Walter K.

AU - Hurley, Leo B.

AU - Ngai, Jen Shieh

AU - Kurman, Robert J.

AU - Sherman, Mark E.

PY - 1999

Y1 - 1999

N2 - 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.

AB - 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.

KW - AGUS

KW - Atypical glandular cells of undetermined significance

KW - Cervix

KW - Cytology

KW - Human papillomavirus

KW - Pap smear

KW - The Bethesda System

UR - http://www.scopus.com/inward/record.url?scp=0032783712&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032783712&partnerID=8YFLogxK

U2 - 10.1016/S0046-8177(99)90143-0

DO - 10.1016/S0046-8177(99)90143-0

M3 - Article

VL - 30

SP - 816

EP - 825

JO - Human Pathology

JF - Human Pathology

SN - 0046-8177

IS - 7

ER -