Management of women with atypical Papanicolaou tests of undetermined significance by board-certified gynecologists: Discrepancies with published guidelines

OBJECTIVE: The Bethesda System introduced 2 categories of atypia: atypical glandular cells of undetermined significance (AGUS) and atypical squamous cells of undetermined significance (ASCUS). Our objective was to test the hypothesis that there is lack of consensus regarding management of women with ASCUS and AGUS. STUDY DESIGN: A 2-page survey was mailed in April 1998 to a random sample of 491 fellows of the American College of Obstetricians and Gynecologists. RESULTS: There were 241 responses (50.6%). For first-time ASCUS, 23.0% of respondents would perform colposcopy and 24.4% would repeat the Papanicolaou test in <3 months, indicating aggressive management of ASCUS by 47.4% of respondents. For recurrent ASCUS, 88.7% followed recommendations to manage with colposcopy. For AGUS, 23% repeated the Papanicolaou test and only 43% would manage appropriately. For recurrent AGUS, only 25% would perform surgical excision. CONCLUSION: Compared with published guidelines, practitioners undermanage patients with AGUS and overmanage patients with ASCUS. Further physician education appears to be warranted.