Management of Atypical Glandular Cells (AGC) Not Otherwise Specified
Initial Evaluation
- The American College of Obstetricians and Gynecologists recommends that all patients with AGC-NOS require immediate colposcopy with endocervical sampling and HPV DNA testing; additionally, women ≥35 years old or those with risk factors for endometrial cancer need endometrial sampling regardless of age 1, 2, 3
- Colposcopy with directed biopsies of any suspicious lesions after acetic acid application is a required component for all patients with AGC-NOS, as recommended by the American College of Obstetricians and Gynecologists 1, 4, 5
- Endocervical sampling using either endocervical curettage or cytobrush is a necessary step in the initial workup of AGC-NOS, according to the American College of Obstetricians and Gynecologists 1, 2, 3
- HPV DNA testing is recommended if not already obtained at the time of colposcopy, as stated by the American College of Obstetricians and Gynecologists 1, 4, 5
Age-Based Additional Requirements
- Women ≥35 years old should undergo endometrial sampling (biopsy, D&C, or hysteroscopy) in addition to the initial evaluation, as recommended by the American College of Obstetricians and Gynecologists 1, 2, 3, 4
- Women <35 years old should undergo endometrial sampling only if risk factors are present, including unexplained vaginal bleeding, chronic anovulation, obesity, unopposed estrogen therapy, polycystic ovarian syndrome, tamoxifen use, or HNPCC, according to the American College of Obstetricians and Gynecologists 1, 4, 6
Management Based on Initial Findings
- For HPV-positive patients, repeat cytology combined with HPV DNA testing at 6 months is recommended, as stated by the American College of Obstetricians and Gynecologists 1, 4, 5
- For HPV-negative patients, repeat cytology combined with HPV DNA testing at 12 months is recommended, according to the American College of Obstetricians and Gynecologists 1, 4, 5
- If CIN (without glandular neoplasia) is found, management should follow standard CIN guidelines based on grade, as recommended by the American College of Obstetricians and Gynecologists 1, 4, 5
- If glandular neoplasia or AIS is found, a diagnostic excisional procedure is mandatory, preferably cold knife conization over LEEP, as stated by the American College of Obstetricians and Gynecologists and the National Comprehensive Cancer Network 1, 4, 6
Special Populations
- Pregnant women should undergo initial evaluation identical to non-pregnant women, except that endocervical curettage and endometrial biopsy are contraindicated, as recommended by the American College of Obstetricians and Gynecologists 1, 4