OB-GYN-L Messages for April, 2005: Re: AGUS

Re: AGUS

From: art fougner, md

evsono@pipeline.com

Fri Apr 29 07:38:58 2005

Acta Cytol. 2000 Jan-Feb;44(1):41-5.

Cytohistologic correlation between AGUS and biopsy-detected lesions in postmenopausal women.

Obenson K, Abreo F, Grafton WD.

Department of Pathology, Louisiana State University Medical Center, Shreveport 71130, USA.

OBJECTIVE: To evaluate histologic findings in patients aged 50 and older whose cervical smears revealed atypical glandular cells of undetermined significance (AGUS). STUDY DESIGN: Computerized records spanning a four-year period were retrospectively analyzed. Thirty patients over age 50 had cervical smears interpreted as AGUS and had follow-up biopsies within 12 months following the abnormal smear. The most important histologic diagnosis from the biopsy specimens was correlated with the subcategory of the cervical smear. RESULTS: Five smears interpreted as AGUS, favor reactive, revealed abnormal histology in four cases: three endometrial polyps and one squamous carcinoma. Two smears interpreted as AGUS, favor dysplasia, revealed squamous intraepithelial lesions on biopsy in both cases. Seventeen smears interpreted as AGUS, favor endometrial cells, revealed abnormal histology in 13 cases: 1 endocervical polyp, 6 endometrial polyps, 3 endometrial hyperplasias and 3 adenomyosis. Six patients with smears interpreted as AGUS, unclassifiable, revealed abnormal histology in five cases: two endocervical polyps, one endometrial polyp, one endometrial carcinoma and one ovarian carcinoma. CONCLUSION: The presence of AGUS in cervical smears from women over 50 was highly predictive of abnormal lesions detected by histologic examination. Although three cancers were detected on histologic follow-up, the most common lesions detected were endometrial polyps.

art

At Thu, 28 Apr 2005, Joanne Bulley, MD wrote: >
>Garry
>
>You are right and - yes - before hyst - I would do a cold knife cone,
>ECC of upper endocervix and Endometrial assessment.
>
>With this case it is noteworthy that she had the prior LEEP in March 04
>with negative ECC. (I always do an ECC above my LEEP or cold knife cone
>... but the results from the ECC with the LEEP are at the office and I
>am home.)
>
>What do you make of her previous VIN 3 (1998) of the posterior introitus
>... prior cryo (?1993) for CIN ... the CIN on this cone and the
>"negative" for high Risk HPV?
>
>Obviously - she carries a different strain of HPV that is high risk ...
>or does she have an immune system problem (and should it be worked up)
>that allows genital tract carcinomas to get started?
>
>Joanne
>
>At Thu, 28 Apr 2005, Garry E. Siegel, M.D. wrote:
>>
>>Hey, check out the ASCCP guidelines. http://www.asccp.org/
>>
>>Before you do a TVH and find an undiagnosed cancer (unlikely, but. .
>>.), if you cannot access her cervix due to stenosis, why not do an OR
>>visit:
>>
>>1. Cold knife cone--unless you feel the cervix is "cleared" and it
>>doesn't need evaulation.
>>2. ECC
>>3. Hysteroscopy/endometrial curettage
>>
>>Unless I'm missing something, you have an unexplained AGUS smear (CIN
>>doesn't fully cover that) and you've not been able to evaluate the
>>endometrium or the endocervix.
>>
>>Garry
>>
>--
>Joanne Bulley, MD
>Keene, NH, USA
>

-- art fougner, md

"If you don't know where you are going, you will wind up somewhere else." Lawrence Peter Berra

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