III. Pathophysiology
- Not equivalent to ASCUS Pap Smear
- Much higher likelihood of associated Cervical Dysplasia
- No abnormality on Colposcopy: 50 to 80%
- See benign causes below
- Significant abnormality on Colposcopy: 20 to 50%
- See significant causes below
- No abnormality on Colposcopy: 50 to 80%
IV. Causes: AGUS Pap Smear
- Significant abnormalities
- Cervical Dysplasia associated with squamous lesions
- Adenocarcinoma in situ
- Adenocarcinoma
- Benign abnormalities
- Metaplasia
- Endometriosis
- Arias-Stella reaction associated with pregnancy
- Endocervical polyps
V. Signs: Colposcopy of Adenocarcinoma and AIS (subtle)
- Typical squamous Cervical Dysplasia findings not seen
- Findings (observe before acetic acid application)
- Dull orange or yellow (adenocarcinoma)
- Occurs in transition zone under columnar epithelium
- Variegated red and white lesions
- Papillary lesions
- Large gland openings
- Unusual vascular patterns
- Vessels in pattern of tendrils or roots
- Vessels in pattern of written characters
VI. Evaluation
- Colposcopy with directed biopsy in all endocervical sample in all AGUS and
-
Endometrial Biopsy indications
- Age over 35 years or
- Abnormal Uterine Bleeding or
- Atypical endometrial cells on Pap Smear cytology
VII. Management: AGUS Favor Reactive or NOS (2014 and 2019 Guidelines)
- Positive Colposcopy (CIN 2 or worse, but no glandular neoplasia)
- See 'Favor Neoplasia' below if glandular neoplasia
- Negative Colposcopy and ECC (No CIN 2,3 AIS or Cancer)
- Cotest HPV and Cervical Cytology in 12 and 24 months
- Colposcopy if any abnormality, otherwise repeat HPV and Cervical Cytology in 3 years
VIII. Management: AGUS Pap Smear Favor Neoplasia or AIS (2014 Guidelines)
- Perform Colposcopy
- Negative ECC: Cone biopsy (or other diagnostic excisional procedure) as below
- Positive ECC: Consider Hysterectomy
- Perform Cone Biopsy (Cold-knife conization) with interpretable margins
- Cone Biopsy positive for Cervical Cancer
- Radical Hysterectomy with or without radiation
- Cone Biopsy positive for Adenocarcinoma in situ
- Simple Hysterectomy
- Cone Biopsy negative
- Consider Endometrial Biopsy (esp. age over 35)
- Cone Biopsy positive for Cervical Cancer
IX. Resources
- (2014) ASCCP Guidelines
- (2019) ASCCP Guidelines