Managing ASCUS and AGUS Pap smears

More than half of all high-grade lesions are preceded by an ASCUS or AGUS Pap smear. By adopting definitive management strategies for these types of abnormal cytology, Ob/Gyns have a unique opportunity to prevent cervical cancer.

Dr. Gerbie is section chief of gynecology at Northwestern University Medical School in Chicago, Ill.

With the newest iteration of the Bethesda System in place—the second revision in 10 years—the clinician is again asked to learn new classifications of cervical cytology and the attendant management protocols. One purpose of the new system is to eliminate the confusion and variability of the previous Papanicolaou (Pap) Class II smear and the CIN Class 2R smear, both of which acted as “hedges” to let the clinician decide on management.¹

Under the newest system, atypical squamous cells are subclassified into ASC-US (undetermined significance) and ASC-H (cannot exclude high-grade dysplasia). Atypical glandular cells of undetermined significance (AGUS) also have been subclassified. The reason: To create specific readings of cell changes, as atypical cells often are seen prior to dysplasia. In fact, in a 1998 Kaiser review, 52% of high-grade lesions were preceded by either a smear of ASCUS or atypical glandular cells of undetermined significant (AGUS). The most frequent precursor smear was ASCUS (43.6%).²