Gynecology Book

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AGUS Pap Smear

Aka: AGUS Pap Smear, Atypical Glandular Cells of Undetermined Significance
  1. Epidemiology
    1. Incidence: 0.18 to 0.74% of Pap Smears
  2. Pathophysiology
    1. Not equivalent to ASCUS Pap Smear
    2. Much higher likelihood of associated Cervical Dysplasia
      1. No abnormality on Colposcopy: 50 to 80%
        1. See benign causes below
      2. Significant abnormality on Colposcopy: 20 to 50%
        1. See significant causes below
  3. Causes: AGUS Pap Smear
    1. Significant abnormalities
      1. Cervical Dysplasia associated with squamous lesions
      2. Adenocarcinoma in situ
      3. Adenocarcinoma
    2. Benign abnormalities
      1. Metaplasia
      2. Endometriosis
      3. Arias-Stella reaction associated with pregnancy
      4. Endocervical polyps
  4. Signs: Colposcopy of Adenocarcinoma and AIS (subtle)
    1. Typical squamous Cervical Dysplasia findings not seen
    2. Findings (observe before acetic acid application)
      1. Dull orange or yellow (adenocarcinoma)
      2. Occurs in transition zone under columnar epithelium
      3. Variegated red and white lesions
      4. Papillary lesions
      5. Large gland openings
      6. Unusual vascular patterns
        1. Vessels in pattern of tendrils or roots
        2. Vessels in pattern of written characters
  5. Evaluation
    1. Colposcopy with directed biopsy in all endocervical sample in all AGUS and
    2. Endometrial Biopsy indications
      1. Age over 35 years or
      2. Abnormal Uterine Bleeding or
      3. Atypical endometrial cells on Pap Smear cytology
  6. Management: AGUS Favor Reactive or NOS
    1. Positive Colposcopy (CIN 2 or worse, but no glandular neoplasia)
      1. See 'Favor Neoplasia' below if glandular neoplasia
    2. Negative Colposcopy and ECC (No CIN 2,3 AIS or Cancer)
      1. Cotest HPV and Cervical Cytology in 12 and 24 months
      2. Colposcopy if any abnormality, otherwise repeat HPV and Cervical Cytology in 3 years
  7. Management: AGUS Pap Smear Favor Neoplasia or AIS
    1. Perform Colposcopy
      1. Negative ECC: Cone biopsy (or other diagnostic excisional procedure) as below
      2. Positive ECC: Consider Hysterectomy
    2. Perform Cone Biopsy (Cold-knife conization) with interpretable margins
      1. Cone Biopsy positive for Cervical Cancer
        1. Radical Hysterectomy with or without radiation
      2. Cone Biopsy positive for Adenocarcinoma in situ
        1. Simple Hysterectomy
      3. Cone Biopsy negative
        1. Consider Endometrial Biopsy (esp. age over 35)
  8. References
    1. (2014) ASCCP Guidelines
      1. http://www.asccp.org/Guidelines-2/Management-Guidelines-2
    2. Apgar (2009) Am Fam Physician 80(2): 147-55 [PubMed]
    3. Cox (1997) J Low Genit Tract Dis 1:41-5 [PubMed]
    4. Kaferle (2001) Am Fam Physician 63(11):2239-44 [PubMed]
    5. Dinh (1999) J Low Genit Tract Dis 3:73-6 [PubMed]
    6. Wright (2002) J Low Genit Tract Dis 6:127-43 [PubMed]

Atypical glandular cells of undetermined significance (C0521185)

Definition (NCI_NCI-GLOSS) A term that has been used to describe abnormal cells that come from glands in the walls of the cervix (the lower, narrow end of the uterus). These abnormal cells are found in a small number of Pap smears (a procedure used to detect cervical cancer) and may be a sign of more serious lesions or cancer. The term used now is atypical glandular cells.
Concepts Cell or Molecular Dysfunction (T049)
SnomedCT 4476003
Dutch atypische kliercellen met onduidelijke betekenis, AGUS
French Cellule glandulaire atypique de signification indéterminée (AGUS), Cellules glandulaires atypiques de signification indéterminée
German atypische glandulaere Zellen unbekannter Signifikanz, AGUS
Italian Cellule ghiandolari atipiche di significato incerto, AGUS
Portuguese Células glandulares atípicas de significação indeterminada, AGUS (célula glandular atípica de significação indeterminada)
Spanish Células glandulares atípicas de significado indeterminado, AGUS, atipismo de células glandulares de significación indeterminada (AGUS), células glandulares atípicas de significación indeterminada (AGUS) (anomalía morfológica), células glandulares atípicas de significación indeterminada (AGUS)
Japanese イギフメイイケイセンサイボウ, 意義不明異型腺細胞
Czech Atypické žlázové buňky neurčeného významu, AGUS
English abnormal glandular cells of undetermined significance (AGUS), agus, atypical glandular cells of uncertain significance, atypical glandular cells of undetermined significance, AGUS, Atypical glandular cells of uncertain significance, Atypical glandular cells of undetermined significance (morphologic abnormality), Atypical glandular cells of undetermined significance, Atypical Glandular Cell of Uncertain Significance, Atypical Glandular Cell of Undetermined Significance, Atypical Glandular Cells of Uncertain Significance, Atypical Glandular Cells of Undetermined Significance
Hungarian AGUS, Meghatározatlan jellegű atypusos glandularis sejtek
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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