Negative colposcopyendocervical curettage

a. AGC not otherwise specified. Women with AGC NOS who have a normal initial colposcopic evaluation and endocervical biopsy can be followed with cervical cytology at four to six month intervals until four consecutive tests are negative for intraepithelial lesions or malignancy. They are then followed with routine surveillance.

b. AGC favor neoplasia or AIS. A cold-knife conization is the best procedure for subsequent evaluation of AGC lesions at high risk of associated adenocarcinoma, such as AGC favor neoplasia or AIS.

5. Endocervical adenocarcinoma in situ (AIS) and adenocarcinoma are separate categories of glandular cell abnormality. Colposcopy with directed biopsy is required. A diagnostic excisional procedure is also needed.

6. Endometrial cells. Occasionally, normal appearing endometrial cells will be reported on a Pap smear. The presence of these cells is reported only in women >40 years of age. In these cases, endometrial biopsy should be performed.

E. Follow-up after treatment. Follow-up Pap smears are recommended every three to four months for the first year after any treatment for dysplasia. Women with cervical dysplasia present at the LEEP or cone margin or in the concomitant endocervical curettage also need follow-up colposcopy with endocervical sampling every six months for one year. Routine surveillance can be resumed if there is no recurrence after the first year. Surveillance consists of Pap smears on a yearly basis for most women and on a twice-yearly basis for high-risk women (ie, HIV positive).

References: See page 184.

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