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Old 03-17-2009, 07:40 AM   #1
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AGUS on pap

A little history - 11/07 had abnormal pap - had colpo - then leep done 2/08 - then follow-up paps every 3 mo's - which were normal until the last one done 2/09 - it came back as stating "epithelial cells abnormal" and then AGUS - atypical glandular cells of undetermined significance are present. I think that is one of my questions - how can my pap change from normal in Oct 08 to this AGUS in just 3 months?

My postcard from my ob/gyn's office that i received last week said my pap results were "normal". So you can see I was a little confused when the results of the pap were mailed separately to me - actually i'm ****** off at the ob/gyn - she never even called me to let me know of the above results - it was like she saw the word Negative next to the HPV classification and that was it.

After all the reading of AGUS - I definitely feel like i should follow up with gyn/oncologist. I am just not sure how to go about addressing this with ob/gyn dr. What do you think - any suggestions or thoughts on what you might do??? I could sure use some advice.

Thanks so much for taking the time to reply! K

 
Old 03-17-2009, 07:54 AM   #2
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Re: AGUS on pap

Totally go stright to the gyn/onc.

I think gynos don't think they need to send you to an oncologist unless it's invasive, but regular gyns just don't know a lot about glandular changes. They don't treat it very often.

I had adenocarcinoma in situ. It was all removed by a cone biopsy, but I'm doing all my follow ups with a gyn/onc.

 
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Old 03-17-2009, 08:49 AM   #3
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Re: AGUS on pap

Hi Redgl, I would definately call the office back and ask about the AGUS.

As far as I know, the only way the pap shows glandular cells is if they are present at the transition zone (TZ). And I am assuming they'd show if they have sloughed off (natural shedding of cells) - but I'm only guessing on that.

What was your original diagnosis that led to the LEEP?

With a history of being followed (after the LEEP) I'd suggest you ask your doctor about doing a colposcopy and asking for an ECC (endocervical curettage). It is the only non-surgical way to sample the glandular cells in the endocervical canal.

I hope that helps a bit!

 
Old 03-17-2009, 09:18 AM   #4
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Re: AGUS on pap

I have to echo Lily's reply. Find yourself a gyn/onc.

I had the same thing happen to me with my ob/gyn that I felt deceived as well (I "heard" CIS - but what was really on the pathology was AIS).

I am getting myself not only an opinion from a gyn/onc - but next week I am switching ob/gyn's to one recommended by my family Dr.

 
Old 03-17-2009, 09:57 AM   #5
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Re: AGUS on pap

Just wanted to say that Pickle is totally right. You should call you doctor and ask them to explain your results exactly. (And the fact that they sent a postcard saying the result was normal and a letter with AGUS!)

Then go to a gyn/onc. The next step will probably be colposcopy with ECC and biopsy. Then you will be able to know what's really going on.

 
Old 03-17-2009, 11:34 AM   #6
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Re: AGUS on pap

Thank you all! I have made an appt with a gyn/onc recommended to me by my primary care dr - thank god for him!

Pickle to answer your question - i was first diagnosed as CIN II and III and HPV positive for like 15 diff variations. After the leep biopsy the report said for cervix - squamous intraepithelial lesion is focally present at cauterized inked surgical margin. then under ecc scraping it said negative for squamous epithelial lesion or carcinoma. Fragments of benign endocervical mucosa with squamous metaplasia and endometrial mucosa with stromal breakdown.

It then gave the pathologist's comment as: some of the neoplastic clusters present within the superficial stroma show irregular contour, which could represent foci of microinvasive disease instead of non-invasive glandular involvement, however the marked cautery effect present in this specimen precludes a more definitive assessment.

I have always thought that those results don't sound very "clear" to me and that I should maybe have pushed for further testing - however she said to just follow up with 3 mo pap smears which i did religiously - and now here i am one year out with these results.

Thanks for listening - it really does help to write it out! K

 
Old 03-17-2009, 12:12 PM   #7
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Re: AGUS on pap

Hi there --

Glad you are following up with a gyn/onc. I am disturbed by the pathologist's comments and would definitely want that followed up! It's terrible that we put such faith in doctors, and think we are doing the best for ourselves, only to find out (or realize) that some docs are good, some not so good, some are thorough, and some not so much....the wildly varying opinions on treatment that you see being given to all of us here is proof of that.

I wish you well at your follow ups, and keep us posted!!

((hugs))

 
Old 03-17-2009, 06:25 PM   #8
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Re: AGUS on pap

K, to clarify, was this recent AGUS accompanied by a NEGATIVE reading on the Digene HC II (hpv test)? The reason the gyn is not all over the AGUS result is because the hpv is negative. Which is no reason to discount AGUS on a pap, but she's following the idea that testing negative for hpv puts you at negligible risk for significant cervical disease. However, women can have advanced cancer without a positive hpv result even though the cancer IS ENTIRELY attributable to hpv. Typically, this is when the problem is more advanced.

Your first hpv test did not come back positive for 15 different variations. I think the Digene HC II tests for 13 (?) high and intermediate risk strains, and if "even just" one is present, you'll have a positive reading. You don't have all 13 or 15 or whatever strains.

The pathologist is saying that the burn margins on your LEEP specimen preclude his differentiation between the presence of invasive squamous cells and atypical glandular cells.

It may be worth your while to get a different pathologist's read. Pathology is a DISTURBINGLY inexact science, and renowned experts disagree more often than agree.

 
Old 04-07-2009, 11:49 AM   #9
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Re: AGUS on pap

Hello everyone - I just wanted to let you all know that I did go and see a gyn-onc today who was recommended by my primary dr. I was honest with him and said that my ob/gyn did not schedule me for any follow up and that i thought after reading my own lab results - that there is something more to my situation - and he agreed. He said and has scheduled me for another colpo/leep/and d&c procedure under general as an outpatient. He also said that he was not going to send my results to my ob/gyn. I told him he could if he wanted to - but I felt she was wrong after reading everywhere that you should always follow up on an agus result on a pap.

I am very glad i went - he was so nice - and most importantly didn't scold me for reading on the internet - which i said i did with the lab results and that was how i came to make the appt with him - because he did make a point at first at how i made it into his office particulary. I am thankful for this board and everyone who reads it and gives input as well. I probably wouldn't always be asking for lab tests if i were not here listening and reading about your experiences. So thank you very much!

Take care Kris

 
Old 04-07-2009, 11:57 AM   #10
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Re: AGUS on pap

So glad to be of assistance! It is so difficult when you trust these doctors and in reality they don't know what they are talking about half the time.

Last edited by Mod-S4; 04-07-2009 at 09:37 PM. Reason: Please let the original poster have her situation discussed here. Thanks.

 
Old 04-07-2009, 06:34 PM   #11
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Re: AGUS on pap

Redgl, it sounds like you had a really good appointment today. A lot can be said toward having a doctor one trusts and is current on research! Yay!

 
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