Atypical Papanicolaou Smear in Pregnancy

Abstract

Papani colaou (Pap) smears that contain atypical squamous cells of undetermined significance can be followed up with repeat smears. However, those that contain atypical glandular cells (AGC) are more likely to be associated with severe underlying conditions and, therefore, warrant particular attention. 1 The diagnosis of AGC by pathologists is difficult as there is a high degree of interobserver variation. [2][3][4][5][6][7] Up to 50% of women with AGC have significant histologic abnormalities, and cancer is present in 19.5% of women with AGC.

Outcomes of pregnant patients with Pap smears classified as atypical glandular cells

“…As women in the Czech Republic tend to have children at a higher age than in the past, a higher frequency of abnormal Pap smears, including AGC, is being detected in pregnant women. Atypical glandular cells represent only approximately 0.09–2.5% of all cytological findings 7,14,15 . A large majority of abnormal smears thus fall under the SIL category.…”

“…To exclude glandular lesions it would be necessary to perform an excisional biopsy even when colposcopy was normal. Nevertheless, due to the documented risks, including pre‐term labour, miscarriage, bleeding, premature rupture of membranes and chorioamnionitis, conization should be performed during pregnancy only in the case of suspected invasive carcinoma 14 . Therefore, our objective was to exclude invasive carcinoma in pregnant patients and postpone further management to the postpartum period.…”

“…Atypical glandular cells represent only approximately 0.09-2.5% of all cytological findings. 7,14,15 A large majority of abnormal smears thus fall under the SIL category. Although AGC is rare, it carries a high risk of underlying pathology.…”

“…Nevertheless, due to the documented risks, including pre-term labour, miscarriage, bleeding, premature rupture of membranes and chorioamnionitis, conization should be performed during pregnancy only in the case of suspected invasive carcinoma. 14 Therefore, our objective was to exclude invasive carcinoma in pregnant patients and postpone further management to the postpartum period. In our group, microinvasive carcinoma was detected only in one woman, who underwent successful conization during pregnancy.…”

The management of cervical glandular intraepithelial neoplasia during pregnancy

“…This case report describes a successful cold knife cone biopsy during pregnancy but risks include pre-term delivery, haemorrhage, infection, rupture of membranes, miscarriage, cervical incompetence or stenosis (Connolly and Evans 2005). Knife cone biopsy was done to give a diagnosis and to exclude invasive disease, which is often found adjacent to areas of cGIN.…”