Obstetrics & Gynecology

Answer 4 Colposcopy with endocervical assessment and endometrial biopsy. A review of 1869 patients with AGC of undetermined significance found that 33.7% of these patients had a squamous intraepithelial lesion of the cervix, 2.5% had adenocarcinoma in situ, and 1% had invasive adenocarcinoma.9 Thus, an evaluation of the entire cervix is indicated, including a colposcopic examination with cervical biopsy and endocervical assessment. Women over age 35 years with chronic anovulation and irregular bleeding are at risk for developing endometrial hyperplasia, the precursor for endometrial cancer. Therefore, endometrial sampling is indicated in all women over age 35 years with AGC of undetermined significance as well as in women younger than age 35 years with abnormal bleeding, morbid obesity, oligomenorrhea, or a clinical evaluation suggesting endometrial cancer.10 If these evaluations do not provide a definitive diagnosis, careful examination of the uterine cavity and upper genital tract (eg, ovaries, tubes) is warranted. Cryotherapy is an option for management of cervical dysplasia without endocervical involvement and thus would not be indicated in this case. Pelvic ultrasound helps to assess the endometrial thickness, structural abnormalities of the uterus, and adnexal structures but does not replace histologic evaluation. Diagnosis should be confirmed before hysterectomy is considered. REFERENCES 9. Eddy GL, Strumpf KB, Wojtowycz MA, et al. Biopsy findings in five hundred thirty-one patients with atypical glandular cells of uncertain significance as defined by the Bethesda system. Am J Obstet Gynecol 1997;177:1188–95. 10. Chhieng DC, Elgert P, Cohen JM, Cangiarella JF. Clinical significance of atypical glandular cells of undetermined significance in postmenopausal women. Cancer 2001;93:1–7. Click here to return to the questions

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