Prevalence of Atypical Glandular Calls of Undetermined Significance (AGUS) from Cervical Pap Smear

Abstract

Prevalence of Atypical Glandular Calls of Undetermined Significance (AGUS) from Cervical Pap Smear

Thaovalai                      Thavaramara        MD

Sumonmal                    Manusirivitnaya    MD

Watchara                     Prutthiphongset   MD

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital

Objective : To determine the prevalence and pathology of women who had atypical glandular cells of undetermined significance (AGUS) from cervical Pap smear at BMA Medical College and Vajira Hospital.

Study design : Descriptive study.

Setting : Division of Gynecologic Oncology, Department of Obstetrics and Gynecology. BMA Medical College and  Vajira Hospital.

Subjects : A total of 45,548 women who were checked for cervical Pap smear during Jan 1, 1997 - May 31, 2000.

Methods : Women with atypical glandular cell of undetermined significance were reported from Pap smear. The outpatient reports, colposcopic reports, cytological reports and histopathological reports of tissue were collected and reviewed.

Main outcome measures : The prevalence of AGUS, colposcopic reports and pathological reports from colposcopic directed biopsy, tissue from endocervical curettage (ECC), fractional curettage (F/C) or loop electrosurgical excision procedure (LEEP)

Results : Within the period of study, 57 AGUS-patients were diagnosed from 45,548 Pap smear specimens (0.12%, 95% CI 0.117-0.123%). Thirty-one evaluable patients were investigated with one or several methods; 8 were selected for colposcopy with ECC (25.8%), 6 colposcopic directed biopsy with ECC (19.4%), 8 colposcopic directed biopsy (25.8%), 1 cervical biopsy (3.2%), 1 colposcopy with ECC with LEEP (3.2%), 1 colposcopy only (3.2%), 1 colposcopy and LEEP (3.2%), 1 vaginal biopsy (3.2%), 3 fractional curettage (9.6%) and 1 cervical biopsy followed by LEEP (3.2%). The histopathological reports were negative in 7 cases (22.6%), chronic cervicitis in 9 cases (29.0%), HPV infection in 4 cases (12.9%), CIN I in 2 cases (6.5%), CIN II-III and CIS in 2 cases (6.45%), adenocarcinoma of cervix in 5 cases (16.1%), adenocarcinoma of endometrium in 5 cases (3.2%) and  adenocarcinoma of vulva in 1 case (3.2%).

Conclusion : The prevalence of AGUS from Pap smear in this study was 0.12% (95% CI 0.117-0.123%). This prevalence was important and clinically significance due to interconnection between AGUS and malignancy. The patients who have the diagnosis of AGUS are highly recommended for extensive investigation and should be followed up with great care.

Key words : atypical glandular cells of undetermined significance, AGUS, Pap smear

Vajira Med J 2002 ; 46 : 9 - 17