The cytologic features depicted in the photomicrograph are those of adenocarcinoma in situ (AIS). For an initial cytologic diagnosis of “atypical glandular cells, favor neoplastic” or “AIS,” neither HPV testing nor repeat cervical cytology is an appropriate next step.
If a cervical cytology test shows AIS, colposcopy is indicated. If no invasive disease is detected, a diagnostic excisional procedure is recommended.
Endometrial sampling is recommended in women 35 years and older, but in conjunction with colposcopy and endocervical sampling.
This is not the recommended next step. Hysterectomy may be warranted, but the decision to proceed with this should take into account many factors, including endocervical excisional biopsy findings, additional testing to evaluate the extent of disease, and the desire to preserve reproductive ability.
If AIS is confirmed on diagnostic excisional biopsy, a hysterectomy is the preferred treatment. If conservative treatment is desired, then a negative surgical margin of excisional biopsy should be achieved, and close long-term follow up might be an appropriate approach. Radiation therapy is not the standard treatment for AIS. Whether radiation therapy is needed depends on the subsequent endocervical excisional biopsy result (evaluating the presence of invasion) and further work-up to evaluate the extent and stage of the disease.
