Exxcellence pearls: ACG in 45 yo

Question 0

How should AGC be managed?

Answer 0

Colposcopy with endocervical sampling.

Endometrial sampling in women over 35 or with high-risk of uterine neoplasia.

Question 1

What is the prevalence of atypical glandular cells on cytology?

What is the prevalence of invasive malignancy with AGC?

Answer 1

3 per 1000 specimens.

2-5%

Question 3

How should AGC NOS with no CIN 2+, AIS, or cancer after initial evaluation be followed?

Answer 3

Co-testing in 12 and 24 months, then 3 years later

Question 3

What considerations are necessary for conization with AGC?

Answer 3

Removal of the entire transformation zone, avoiding tissue disruption or cautery artifact, and endocervical canal sampling.

Question 4

How should AGC favor neoplasia with normal initial evaluation be followed?

How should AIS be followed?

Answer 4

Cervical conization

Same

Question 5

If conization margins are negative for AIS, what follow-up is recommended?

Answer 5

“Long-term follow-up “

Consider co-testing and ECC at 12 and 24 months per Columbus lecturer.

Question 6

What percentage of women with positive margins will have persistent adenocarcinoma in situ?

What treatment is recommended for AIS on conization specimen?

Answer 6

More than 50%

Hysterectomy is preferred. Conization alone is acceptable.

Question 7

What types of neoplasia are associated with AGC?

Answer 7

AIS, cervical adenocarcinoma. Less commonly endometrial cancer. Case reports of fallopian tube, ovarian or intra-abdominal cancers.

Question 8

If conization margins or ECC are positive for AIS, what follow-up is recommended?

Answer 8

Repeat conization is preferred. Reevaluation in 6 months is acceptable. Simple hysterectomy should also be reconsidered.