WOMENS-HEALTH Messages for December, 1999: Re: Uncertain about treatment for AGUS?

Re: Uncertain about treatment for AGUS?

From: William D. McIntosh, MD (anonymous@obgyn.net)
Thu, 30 Dec 1999 13:44:55 -0600 (CST)

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In reply to: terry: "Uncertain about treatment for AGUS?"

At Thu, 30 Dec 1999, terry wrote: >
>Please help me. My pap test came back at the end of August as AGUS. I
>went for a colposcopy on November 1 (the first opening my obgyn had). He
>was unable to do the colposcopy because he said that my cervix was too
>tight. Now I am scheduled for a D&C (to rule out cancer he says) and
>another colposcopy in the hospital. I have read from past posts that a
>D&C is not the best way to determine what is causing this AGUS. I went
>for a second opinion and this doctor told me that she would also add the
>LEEP to the colposcopy and the D&C. Now I am really confused. Also,
>what kind of a cancer might I have, cervical or endometrial or both? I
>am trying to talk to my obgyn about doing a LEEP while I am surgury. Is
>this a good idea? And I sure hope that I haven't waited too long for all
>of this. My obgyn seems to think not.Any help that you could give me
>would be much appreciated.

A pap that indicates AGUS (Atypical Glandular Cells of Undetermined Signifigance) is a real problem diagnostically. This indicates that the pap is picking up potential signs of problems in areas that are distant (relatively speaking) from the transformation zone of the cervix it is designed to screen. In other words, glandular cells on a pap smear are analogous to static, and your doctor does not know exactly where the static is coming from. There are 3 possible sources, all of which need to be evaluated, the mucus producing cells of the endocervix, the endometrial lining of the uterus, and (very, very rarely) the serous fluid producing cells of the Fallopian tubes.

Since there are 3 possible sources of the abnormal cells, multiple evaluations need to be done. At the very least, you need a colposcopy, an endometrial biopsy, and an endocervical curretage (a scrapping of the endocervical lining). Many physicians will substitute a D&C for the endometrial biopsy, as this gets more tissue, and therfor theoretically will provide better information. Still other docs will add a hysteroscopy to get still more information. Performing a LEEP in this circumstance, without a true target, is not the usual approach, and is a bit aggressive for my taste, though it is easy enough to make an arguement in favor of doing so. Note that none of these variations will provide any information on the Fallopian tube, but problems there are rare anyway.

I hope this helps you decide what to do.

-- William D. McIntosh, MD, FACOG Clarksville, TN

This is for educational purposes only. It is not intended to replace consultation and examination by your physician or other health care provider.

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