From the Guidelines
For a 35-year-old nonpregnant patient with atypical glandular cells (AGC) on a Papanicolaou (PAP) test, immediate colposcopy with endocervical sampling and endometrial sampling is recommended. The colposcopy should include a thorough examination of the cervix with application of acetic acid and Lugol's solution to identify any abnormal areas requiring biopsy. Endocervical curettage should be performed to evaluate the endocervical canal, which may harbor lesions not visible during colposcopy. Endometrial sampling is necessary because AGC can originate from the endometrium, especially in patients over 35 years old 1.
Some key points to consider in the evaluation of AGC include:
- The risk of underlying significant lesions, including cervical intraepithelial neoplasia, adenocarcinoma in situ, or invasive carcinoma, is significant, ranging from 5-15% 1
- Glandular cell abnormalities require more extensive initial evaluation due to their potential to represent more serious pathology and their tendency to be located higher in the endocervical canal 1
- Reflex HPV DNA testing or repeat cytology is unacceptable for the initial triage of AGC and AIS, and colposcopy with endocervical sampling is the recommended management 1
If no lesions are identified during these procedures, referral for diagnostic excisional procedure such as a cold knife conization may be warranted to rule out adenocarcinoma in situ or invasive adenocarcinoma. This comprehensive evaluation is crucial because AGC carries a significant risk of being associated with high-grade cervical intraepithelial neoplasia, adenocarcinoma in situ, or invasive carcinoma 1.
It's also important to note that some studies suggest that HPV DNA testing at 12 months or repeat cytology at six and 12 months is recommended in adult women with CIN 1 preceded by ASC-US, ASC-H, or LSIL 1. However, for AGC, the initial evaluation should include colposcopy with endocervical sampling and endometrial sampling, as recommended by the American Society for Colposcopy and Cervical Pathology consensus guidelines 1.
From the Research
Evaluation Recommendations for Atypical Glandular Cells on a PAP Test
The recommended evaluation for a 35-year-old nonpregnant patient with atypical glandular cells (AGC) on a Papanicolaou (PAP) test includes:
- Colposcopy with endocervical sampling, as this allows for the examination of the cervix and the collection of cells from the endocervical canal for further analysis 2, 3, 4
- Endometrial sampling, which may be necessary depending on the patient's age, clinical presentation, and other factors, to rule out endometrial cancer or other abnormalities 2, 3, 5, 4, 6
Rationale for Recommendations
The rationale for these recommendations is based on the findings of several studies, which suggest that:
- AGC on a PAP test can be associated with a range of benign and malignant lesions, including cervical and endometrial cancer 2, 3, 4, 6
- Colposcopy with endocervical sampling is essential for evaluating the cervix and detecting any potential abnormalities 2, 3, 4
- Endometrial sampling may be necessary to rule out endometrial cancer or other abnormalities, particularly in older women or those with certain risk factors 2, 3, 5, 4, 6
Summary of Recommendations
In summary, the recommended evaluation for a 35-year-old nonpregnant patient with AGC on a PAP test includes colposcopy with endocervical sampling and possibly endometrial sampling, depending on the patient's individual circumstances. This approach is supported by the findings of several studies, which highlight the importance of thorough evaluation and follow-up for patients with AGC on a PAP test 2, 3, 5, 4, 6