A 6-Year Experience with Pap Smears in an Urban Adolescent Practice: The Scope and Burden of Abnormalities

Study ObjectiveTo determine the prevalence of cervical dysplasia and adherence to recommendations for referral/follow-up in a group of adolescent girls undergoing routine reproductive health care in a primary care setting.DesignRetrospective review of all screening Papanicolaou (Pap) smears performed between 12/99 and 12/05.SettingAn urban academic adolescent medicine practice in New York City.Participants824 sexually active adolescent girls.Main OutcomesCytology and cervical biopsy results and adherence to follow-up and colposcopy recommendations.ResultsAmong 824 adolescents ages 12–21 years (mean = 17) who underwent 1 to 6 screening Paps, 81% (n = 666) had normal Pap smears only and 19% (n = 158) had at least one abnormal Pap. Of the 1214 screening Pap smears reviewed, only one was suggestive of a high grade lesion, 85 (7%) revealed atypical squamous cells of undetermined significance (ASCUS), 81 (6.6%) showed low-grade squamous intraepithelial lesions (LGSIL), and the rest were normal. Fifteen percent of patients (n = 123) were referred for at least one colposcopy; only 72% (n = 88) complied. Biopsy identified 5 high-grade lesions; 3 patients required cervical Loop Electrosurgical Excision Procedures: Despite appropriate referrals and access to services, 32% of patients with ASCUS and 28% of patients with LGSIL lacked evidence of either follow-up Pap or colposcopy by the time of last review.ConclusionsHigh-grade lesions were rare in our sample, supporting new guidelines for less colposcopy in this age group. Although many adolescents were followed within primary care, achieving appropriate follow-up for those with cervical dysplasia was challenging and often unsuccessful.     

Use of the Papanicolaou Test in Women Under 25 Years of Age in Southern Alberta

ObjectivesThe introduction of the Papanicolaou (Pap) test in Canada has led to a decline in both the incidence of, and mortality from, cervical cancer. However, cervical cancer in women under the age of 25 is rare, and the updated Canadian Task Force on Preventive Health Care recommendations advise against screening by Pap test in this age group. Screening under the age of 25 can lead to false-positive results or to treatment of lesions that may spontaneously regress. The purpose of this observational study was to determine how many Pap tests are performed in women less than 25 years of age despite current guidelines.MethodsData were obtained from the Laboratory Information System of Calgary Laboratory Services for women under and over the age of 25 who underwent Pap testing between September and December 2012 and between February and May 2013.ResultsApproximately 4% of women aged 15 to 19 and 33% of women aged 20 to 24 had Pap tests after the new guidelines were released.ConclusionWomen under the age of 25 continue to undergo unnecessary screening for cervical cancer. This excessive screening may cause physical and psychological harm and may result in unnecessary health care expenditures.     

Adherence to guidelines for follow-up of low-grade cytologic abnormalities among medically underserved women

OBJECTIVE: To determine whether women in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) who had findings on a Papanicolaou (Pap) test of atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSIL) were followed up in accordance with the interim guidelines for management of abnormal cervical cytology. METHODS: For this study period, the guidelines for a Pap result of ASC-US or LSIL specified follow-up by Pap tests repeated every 4 to 6 months for 2 years. If a second report of ASC-US or LSIL was made, the patient was to have colposcopy. We analyzed data from 10,004 women who had a result of ASC-US or LSIL followed by a second ASC-US or LSIL from 1991-2000. RESULTS: As judged by the guidelines, 44% of women who had 2 low-grade abnormalities were followed up appropriately with colposcopy. Among women with 2 ASC-US results, those aged less than 30 years were more likely to receive colposcopy than the other age groups, while women who were aged 60 years and older were more likely to be followed up with a third Pap test. For each of the 4 result groups, American Indian or Alaska Native women had the highest percentages of a third Pap test, whereas Black or African-American women had a higher percentage of no follow-up. CONCLUSION: More than one half of the women studied were not followed up in accordance with the established guidelines for managing abnormal cervical cytology. Factors such as age and race or ethnicity influence whether women with cytologic abnormalities receive appropriate follow-up.     

Can visual inspection with acetic acid be used as an alternative to Pap smear in screening cervical cancer?

ObjectiveTo evaluate the value of visual inspection with acetic acid (VIA) in screening cervical cancer in comparison to Pap smear.Material and methods200 women attending the obstetric and gynecology Department in Zagazig University hospital from December 2011 to November 2012 were included. They were screened using Pap smear and VIA. Colposcopy was done for all women. Positive cases on any screening test were subjected to cervical biopsy.ResultsAcetic acid (VIA) was positive in 24/200 (12%) patients and Pap smear was abnormal in 8 (4%). There were 5 LSIL, 2 HSIL and one with cells suspicious of malignancy. Colposcopy was recorded abnormal in 35 cases (17.5) .18 cases (51.4%) had a Reid score of 0–2 and considered negative .17 cases (48.6%) had a positive colposcopy (Reid 3–8). Cervical biopsy was done on all 35 cases. 44% biopsies were positive and 56% were negative .15 positive biopsies incorporated 11 mild dysplasia, 2 moderate dysplasia, 1 sever dysplasia and one carcinoma in situ. The Pap smear had a sensitivity of 50.1%, specificity of 93.1%, and positive predictive value of 89.3% and negative predictive value of 65.6%. VIA had a sensitivity of 90%, specificity of 37%, and positive predictive value of 52% and negative predictive value of 81%.ConclusionVIA a good screening, simple test, has low cost and high sensitivity in comparison to Pap smear. So, it can be used as alternative screening modality for cervical cancer in low resource locations.     

Differences in cervical cancer screening and follow-up for black and white women in the United States

ObjectiveTo study differences in screening adherence and follow-up after an abnormal Pap test in Non-Hispanic Black (Black) and Non-Hispanic White (White) women.MethodsAn observational cohort study using 2010 National Health Interview Survey cancer module to examine HPV knowledge, screening behavior, and follow-up to abnormal Pap test in Black and White women 18 years of age or older without a hysterectomy. We fit logistic regression models to examine associations between race and primary outcome variables including: HPV awareness, Pap test in the last three years, provider recommended Pap test, received Pap test results, had an abnormal Pap test, recommended follow-up, and adhered to the recommendation for follow-up.ResultsAnalyzing data for 7509 women, Black women had lower odds ratios [OR] for: 1) HPV awareness (71% vs 83%; OR = 0.42; 95% CI = 0.36–0.49); 2) reporting Pap screening was recommended (59% vs 64%; OR = 0.76; 95% CI = 0.66–0.88), and 3) acknowledging receipt of Pap results (92% vs 94%; OR = 0.64; 95% CI = 0.49–0.83). Group differences persisted after covariates adjustment. In adjusted models, Black women had higher odds of reporting recent Pap screening (84% vs 77%; OR = 1.7; 95% CI = 1.42–2.03), but reported lower odds of receiving a follow-up recommendation subsequent to abnormal test (78% vs 87%; OR = 0.54; 95% CI = 0.31–0.95).ConclusionBlack women reported higher cervical cancer screening adherence but lower rates of being informed of an abnormal Pap test and contacted for follow-up treatment. We recommend a multilevel approach to deliver culturally appropriate education and communication for patients, physicians, clinicians in training, and clinic level ancillary staff.     

Impact of Patient-Directed Cytology Results Correspondence Program on Follow-Up of High-Grade Pap Tests

ObjectiveProper follow-up of high-grade (HG) Pap tests is critical to the prevention of cervical cancer. This study evaluated the impact of a patient-directed cytology results correspondence program on follow-up of HG Pap tests among at-risk women aged 21 to 69 in Ontario.MethodsA cohort study with a historical control was used to investigate the impact of a result letter on adherence to follow-up after an HG Pap test. Analyses were conducted on an intention-to-treat basis. The intervention group was defined as women with an HG Pap test in 2014-2016, and the control group included women with an HG Pap test in 2010-2012. Follow-up was defined as a colposcopy or related treatments within 6 months of an HG Pap test. Factors that could influence adherence to follow-up were included as covariates in a multivariable logistic regression model (Canadian Task Force Classification II-2).ResultsThe study population comprised 7088 women in the intervention group and 6887 women in the non-intervention group. The follow-up rate in the intervention group was 86.2% compared with 81.0% in the non-intervention group. Controlling for covariates, women in the intervention group were more likely to have a follow-up (adjusted odds ratio 1.5; 95% confidence interval 1.3–1.6). Other significant factors included being registered to a family physician and the physician's gender.ConclusionsA patient-directed correspondence program that provides Pap test results directly to the woman may reduce loss to follow-up for an HG abnormality, with an increased likelihood that these women will seek and complete a colposcopy and related treatment.     

Vulvar intraepithelial neoplasia in adolescents with abnormal Pap smear results: a series report

OBJECTIVE: The objective of this study was to determine the prevalence of vulvar intraepithelial neoplasia (VIN) in adolescents presenting for cervical colposcopy in an adolescent gynecology office. MATERIALS AND METHODS: We conducted a retrospective chart review from 1999 to 2002 of the concomitant diagnosis of cervical intraepithelial neoplasia and VIN in our private general pediatric and adolescent practice in patients younger than 22 years of age who underwent cervical colposcopy as well as evaluation of the vulva secondary to gross and microscopic visualized lesions. RESULTS: Sixty-one patients underwent colposcopy for abnormal Pap smears; we found a 10% overall prevalence of vulvar intraepithelial neoplasia. Forty-four percent (n=27) underwent concomitant evaluation of the vulva; from these, 22% (n=6) fulfilled the characteristics of vulvar and cervical intraepithelial neoplasia. CONCLUSION: In the presence of cervical cytology abnormalities, VIN may be more common than recognized and careful screening is definitely warranted.     

Cervical screening in under 25s: a high-risk young population

OBJECTIVE: The changes to the UK NHS cervical screening programme launched in April 2004 recommend that the first cytological screening should be undertaken at the age of 25 years rather than at 20 years. This study analyses Papanicolaou smear diagnoses of women under 25 years in Lewisham Borough of London to determine the incidence of cervical intraepithelial neoplasia (CIN) in this age group. There are concerns that delaying the onset of cervical screening in this population may increase the risk of cervical cancer. STUDY DESIGN: Pap smear results of 2793 women (2617 between 20 and 24 years and 176 below 20 years) over a period of 1 year from 1 April 2003 to 31 March 2004 were analysed. Appropriate colposcopy referrals and the results of cervical biopsies performed were followed up. RESULTS: Of the 2793 cervical smears analysed: 1997 (71.5%) were normal; 375 (13.4%) inadequate; 144 (5.1%) borderline; 208 (7.4%) showed mild dyskaryosis and 69 (2.5%) showed high-grade lesions (moderate to severe dyskaryosis). One hundred and eighty-two women were referred to colposcopy: 34% showed histological evidence of high-grade precancerous lesions (CIN 2 or 3); 27% CIN 1 and 0.5% koilocytosis only. Thirteen percent had normal colposcopy while 22% did not attend. CONCLUSION: The Lewisham population of young women under the age of 25 years is vulnerable to potential precancerous cervical lesions. This may reflect a high level of sexual activity among the young girls. Absence of screening in this age group may miss these high-grade cervical lesions that could progress to cervical cancer in the near future. We reinforce the importance of cervical screening in the highly vulnerable sexually active population under 25.     

In-situ-Karzinome von Vulva, Vagina und Zervix

Since the 1970s the incidence and mortality of cervical cancer has decreased due to population-based screening programs. Screening is primarily based on annual Pap smears, and colposcopy is indicated in special cases with abnormal cytology. In recent years the guidelines for cervical cancer screening have been updated. Colposcopy is an integral part of these guidelines. Especially American and British guidelines place emphasis on colposcopy. In the article we present principles, indications and innovations of colposcopy. We emphasize the significance of colposcopy, vulvoscopy and vaginoscopy in the present guidelines and the role of colposcopy for diagnosis and treatment of precancerous lesions.     

Screening for cervical cancer in high-risk populations: DNA pap test or Hybrid Capture II test alone?

This study was designed to evaluate whether Hybrid Capture II (HC2) test alone refer women to colposcopy as appropriately as DNA Papanicolaou (Pap) test, in the context of a high-risk group of women using the recently validated DNACitoliq LBC system. Women with suspected cervical disease were included in this cross-sectional study at a tertiary center in S?o Paulo, Brazil, for further workup. All women had cervical material collected for LBC and HC2 for high-risk human papillomavirus (hrHPV)-DNA test. Irrespective of cytology and HC2 results, colposcopy, and cervical biopsy when applicable, was systematically performed. All tests were performed blindly. Sensitivity, specificity, positive and negative predictive values, and overall accuracy of both methods were computed in relation to histology. A total of 1,080 women were included: 36.4% (393/1080) had ACUS+, 10.2% (110/1080) were high-grade squamous intraepithelial lesions (HSIL) or cancer. Mean age was 33.5 years. All women underwent colposcopy, and cervical biopsies were performed in 38.4% (415/1080): 33% (137/415) of the biopsies were negative, 14.4% (155/415) were low-grade squamous intraepithelial lesions (LSIL), 10.7% (116/415) were HSIL, and 0.6% (7/415) were cancer. HC2 sensitivity to diagnose biopsy-proven HSIL was 100%. Because all HSIL cases had a positive HC2 test, sensitivity could not be improved by adding LBC. Specificity and positive and negative predictive values of DNA Pap were not significantly different from HC2 test alone when considering LSIL+ histology as "gold standard" and HSIL+ histology. As a screening strategy for women with high-risk for cervical cancer, DNA Pap test does not seem to add substantially to HC2 alone in terms of appropriately referring to colposcopy.     

Trends in cervical cancer incidence in younger US women from 2000 to 2013

Objective

This study aimed to assess the temporal trends in invasive cervical cancer (ICC) incidence rates among 21–25 year-olds. US guidelines no longer recommend screening prior to age 21, and concerns have been raised that delayed screening initiation may increase ICC incidence among young women.

改良取样巴氏涂片在人群子宫颈癌筛查中的应用

目的：探讨改良取样巴氏涂片（Pap）在子宫颈癌筛查中的应用价值。方法：对500例30~59岁、3年内未行宫颈癌筛查的妇女行改良Pap、液基细胞学（LCT）和第二代杂交捕获实验（HC-Ⅱ）人乳头瘤病毒（HPV）检测,Pap采用液基细胞学刷取样,2种细胞学取样采用分配样本法。细胞学以无明确诊断意义不典型鳞状细胞（ASCUS）为阳性阈值,对任一细胞学结果或HPV检测阳性的妇女行阴道镜下宫颈多点活检,以病理诊断为金标准,评价2种细胞学方法筛查宫颈癌的价值。结果：宫颈细胞学筛查宫颈上皮内瘤样病变（CIN）Ⅱ以上病变以ASCUS为阳性阈值的筛查效率最高;改良Pap和LCT的筛查效率（ROC曲线下面积比较,Z ＝0.70,P ＞0.05）和不满意率（χ2＝0.343,P =0.558）差异无统计学意义;两种细胞学的诊断完全一致率为86.8%,宫颈癌和宫颈癌前病变级别越高,2种细胞学方法判读结果的一致性越好。结论：改良Pap经济有效,可广泛应用于人群子宫颈癌筛查。     

Unintended Consequences: The Impact of Cervical Cancer Screening Guidelines on Rates of STI Screening in Primary Care

ObjectiveIn 2012, cervical cancer screening guidelines in Ontario shifted from recommending yearly Pap testing to recommending Pap tests every 3 years. We sought to investigate how these changes have impacted rates of sexually transmitted infection (STI) screening in young women.MethodsWe conducted a retrospective cohort study of 600 patients aged 19–25 years who presented to 1 of 2 community family health teams from May 1, 2009 to April 30, 2012 (the annual Pap test group) or from Nov 1, 2012 to Oct 31, 2015 (the triennial Pap test group). The primary outcome was the number of visits at which STI screening was performed. Secondary outcomes were presence/absence of STI screening over a 3-year period and method of screening used.ResultsA significant decrease was observed in the number of visits at which STI screening was performed, with the annual group averaging 1.21 visits/patient compared with 0.82 visits/patient for the triennial group (P = 0.001). A decrease in the proportion of patients screened over 3 years was also observed (66.8% vs. 52.8%, P = 0.007). A significant decrease in the use of endocervical culture (1.06 vs. 0.57 tests/patient, P <0.001), and a non-significant increase in urine NAAT (0.09 vs. 0.17, P = 0.07) and serum STI screening (0.37 vs. 0.47, P = 0.16) was observed.ConclusionsThe 2012 Ontario cervical cancer screening guidelines were associated with a decrease in STI screening among women aged 19–25 years in the primary care setting. This unintended effect of guideline changes highlights a need for STI screening practices that are independent of routine pelvic examinations.     

Sociodemographic factors associated with cervical cancer screening coverage and follow-up of high grade abnormal results in a population-based cohort

IntroductionA cervical cytology based screening program is effective if there is regular screening of the ‘at risk’ population and close follow-up of those labeled abnormal.MethodsThis is a population cohort study of women between 20-69 year old who were eligible in Ontario from 2008-2010. We used administrative data to evaluate the rates of cervical cancer screening and follow-up of high grade Pap tests. Variation in cervical cytology coverage and follow-up of high grade abnormal results are associated with age, area level income and health region. Multivariate logistic regression was used to identify independent factors associated with screening and followup.Results3.7 million women were eligible for screening of which 72% had a Pap smear in the prior 3 years. These rates varied by age, income and region (p < 0.0001). Women residing in the lowest income neighborhoods were half as likely to be screened (p < 0.0001). 83% of those with an high grade intraepithelial lesion Pap test result had follow-up with colposcopy or treatment within 6 months and this varied by year, age, income and region (p < 0.0001).ConclusionsDespite universal health coverage, cervical cancer screening rates are suboptimal with older and low income women being at greatest risk. Follow-up among women with high grade abnormal tests is mediocre at 3 months and acceptable at 6 months. Novel models of cervical cancer screening program implementation are needed to address these inadequacies.     

宫颈巴氏涂片与LCT在低收入妇女妇科普查中的应用

目的探讨宫颈巴氏涂片与液基细胞学（LCT）在低收入已婚妇女宫颈癌筛查中的应用价值。方法2008年1月至6月上海市浦东新区妇幼保健院对所在社区6416例低收入已婚妇女（低收入组）采用宫颈巴氏涂片进行了宫颈癌筛查,其中322例同期行LCT,并与同期来上海市浦东新区妇幼保健院做宫颈癌筛查行LCT的294名妇女进行对照（对照组）。结果①宫颈刮片巴氏异常者（≥Ⅱb级）低收入组中22例（0．34％）,其中Ⅱb级12例（0．19％）,Ⅲ级10例（0．16％）,无Ⅳ级及Ⅴ级。15例（Ⅱb5例,其余Ⅲ级）行阴道镜下活检,病理结果CIN8例,其中CIN12例,CIN2和CIN3各3例;②低收入组同期行LCT的322例妇女中,细胞学≥ASCUS共41／322例（12．73％）,其中ASCUS15例,HSIL 1例,行阴道镜下活检病理结果CIN5例（CIN1和CIN2各2例,CIN31例）;HSIL1例为子宫颈鳞状细胞癌。对照组：细胞学≥ASCUS 22／294例（7．48％）。其中ASCUS 11例行阴道镜下活检。病理结果仅CIN 21例;2例LSIL;1例为CIN2。两组AGC各1例经阴道镜下活检均无异常;③低收入组中322例行宫颈刮片和LCT做自身对照：315例巴氏均为Ⅰ级,LCT正常;巴氏Ⅱb级2例,LCT均为ASCUS,病理分别为CIN1和CIN2;巴氏Ⅲ级3例,LCT检查,其中2例为ASCUS,阴道镜活检仅1例病理为CIN2。结论宫颈细胞学是筛查宫颈病变的有效手段,巴氏涂片法在基层对低收入人群仍可为主要筛查方法。有条件者可采用LCT,以提高宫颈疾病筛查的敏感性。     

The combined impact of implementing HPV immunisation and primary HPV screening in New Zealand: Transitional and long-term benefits,costs and resource utilisation implications

BackgroundIn response to emergent evidence, many countries are transitioning from cytology-based to HPV screening. We evaluated the impact of an upcoming transition on health outcomes and resource utilisation in New Zealand.MethodsAn extensively validated model of HPV transmission, vaccination, natural history and cervical screening (‘Policy1-Cervix’) was utilised to simulate a transition from three-yearly cytology for women 20–69 years to five-yearly HPV screening with 16/18 genotyping for women 25–69 years, accounting for population growth and the impact of HPV immunisation. Cervical cancer rates, resources use (test volumes), costs, and test positivity rates from 2015 to 2035 were estimated.FindingsBy 2035, the transition to HPV screening will result in declines in cervical cancer incidence and mortality rates by 32% and 25%, respectively, compared to 2018. A potentially detectable 5% increase in cervical cancer incidence due to earlier detection is predicted for the year of transition. Annual numbers of women screened will fluctuate with the five-year screening interval. Cytology volumes will reduce by over 80% but colposcopy volumes will be similar to pre-transition rates, and program costs will be reduced by 16%. A 9% HPV test positivity rate is expected in the first round of HPV screening (2019–2023), with 2.7% of women referred for colposcopy. Transitioning from cytology to primary HPV cervical screening could avert 149 cancer cases and 45 deaths by 2035.ConclusionPrimary HPV screening and vaccination will reduce cervical cancer and resources use. A small transient apparent increase of invasive cancer rates due to earlier detection may be detectable at the population level, reflecting the introduction of a more sensitive screening test. These findings can be used to inform health services planning and public communications surrounding program implementation.     

Endocervical curettage in evaluating abnormal cervical cytology

OBJECTIVE: To determine the role of endocervical curettage (ECC) in the evaluation of women with abnormal cervical cytology and following treatment for cervical intraepithelial neoplasia. STUDY DESIGN: A retrospective chart review using the records of 2,126 patients who were seen at the Colposcopy Clinic, Baylor College of Medicine, between 1980 and 1995. All patients were referred because of an abnormal cervical smear and underwent repeat Pap smear, colposcopic examination in each case with biopsies as indicated, endocervical curettage and treatment, consisting of either cryotherapy, laser vaporization or a LOOP electrosurgical excision procedure. Following treatment, Pap smears were performed on a scheduled basis, and ECC was performed annually. RESULTS: The ECC was negative in 1,849 (87%) of the women. It was abnormal in 33% of women with unsatisfactory colposcopy and 10% of women with satisfactory colposcopy. ECC was abnormal in 21% of patients with a negative biopsy result and 42% of patients who did not have a biopsy performed. There was a significant increase in abnormal ECC results with increasing age. ECC had a high positive predictive value for ectocervical disease (86%) and a high negative predictive value for endocervical disease (90%). One year following treatment, < 4% of patients with a negative cervical smear had a high grade lesion detected on ECC. CONCLUSION: The use of ECC is helpful in detecting disease missed by routine colposcopy and biopsy and is most likely to detect ectocervical disease rather than true endocervical disease. Following treatment, ECC does not appear to be significantly more reliable than the Pap smear in detecting the presence of significant residual disease.     

Shanxi Province Cervical Cancer Screening Study: a cross-sectional comparative trial of multiple techniques to detect cervical neoplasia

OBJECTIVE: The aim of this study was to design a cervical cancer screening algorithm for the developing world that is highly sensitive for cervical intraepithelial neoplasia (CIN) II, III, and cancer and highly specific for CIN II and III, making it possible to ablate the transformation zone without histologic confirmation. METHODS: In rural Shanxi Province, China, we examined 1997 women ages 35-45. Each subject underwent a self-test for intermediate and high-risk HPV (by HC-II assay), fluorescence spectroscopy, a liquid-based Pap (read manually and by computer and used as a direct test for HPV), a visual inspection (VIA) diagnosis, and colposcopy with multiple cervical biopsies. RESULTS: Mean age was 39.1 +/- 3.16 years, mean number of births was 2.6 +/- 0.93. Based on tests administered, 4.3% subjects had > or =CIN II. All subjects with > or =CIN II had either a ThinPrep Pap (> or =ASCUS) or a positive HPV direct test. The sensitivity and specificity for the detection of > or =CIN II were, respectively, 83 and 86% for the HPV self-test, 95 and 85% for the HPV direct test, 94 and 78% for the ThinPrep Pap (> or =ASCUS), 77 and 98% for the ThinPrep Pap (> or =HGSIL), 94 and 9% for fluorescence spectroscopy, 71 and 74% for VIA, and 81 and 77% for colposcopy. CONCLUSION: Based on these data and the existing healthcare infrastructure in China, we believe that further refinement of primary HPV screening using centralized labs is indicated. Self-testing in the local villages may be effective with improvements in the devices and techniques.     

Lack of adherence to practice guidelines for women with atypical glandular cells on cervical cytology

OBJECTIVE: We sought to estimate the rates and types of evaluation in women with atypical glandular cells of undetermined significance (AGC-US) on cervical cytology and to assess these findings on the basis of published management guidelines. METHODS: The rates of histologic sampling, comprehensive initial evaluations, and secondary evaluations were assessed in 477 women with an AGC-US Pap test from 1998 to 2001. A comprehensive evaluation was defined as a colposcopy and an endocervical curettage with or without a cervical biopsy. For women aged 35 or older, a comprehensive evaluation also included an endometrial biopsy. A secondary evaluation consisted of a diagnostic cone biopsy. RESULTS: Sixty-four percent of women with an AGC-US Pap test had histologic sampling; 36% were followed by repeat Pap test only. Thirty-six percent of women with an AGC-US Pap test had a comprehensive evaluation. Women with an AGC-US Pap test that was subclassified as malignant-appearing had higher rates of histologic and comprehensive evaluations than women with a benign-appearing or unspecified AGC-US Pap test (P < .01). Twenty-eight percent of women aged 35 or older had comprehensive evaluations compared with 57% of women younger than the age of 35 (P < .01). Secondary evaluations were performed in 8% of women with persistent AGC-US Pap tests and 2% of women with malignant-appearing AGC-US Pap tests after negative initial histologic evaluations. Twelve of the 42 cases of disease (29%) were diagnosed more than 1 year from the initial AGC-US Pap test. CONCLUSION: On the basis of accepted management guidelines, these data suggest that women with AGC-US Pap tests are undermanaged in both their initial and secondary evaluations.