Cancer Therapy Vol 3, page 437 Figure 1. Age distribution of women with an AGUS Pap smear.
Biopsies for histologic diagnoses were done in 57 patients (83.8%). Three of these had a history of LEEP due to cervical squamous intraepithelial neoplasia and 3 were in a postpartum state. For histologic diagnosis, we performed colposcopy directed p-Bx, ECC, EMBx, the LEEP, or hysterectomy separately or in combination. The types of initial procedures performed in patients that underwent histologic evaluation are shown in Table 1, and according to the result of these initial procedures, additional procedures or operations were performed. Two cases underwent an operation without another histologic evaluation after AGUS Pap smear. One of these underwent hysterectomy due to a fibroid of the uterus and the histologic result revealed a normal endometrium and cervix. The other case underwent a Pap smear during diagnostic work up, and a CT scan showed a lesion with a
high probability of malignancy; she underwent explorative laparotomy, and was diagnosed as ACUP (Adenocarcinoma of Unknown Primary). The histologic outcomes of patients with an AGUS Pap smear are shown in Table 2. Of the 57 women with a histologic follow-up, 18 (31.6%) had clinically significant findings. Seven cases (12.3%) had endometrial cancer, 6 cases (10.5%) cervical adenocarcinoma, 3 cases (5.3%) a squamous intraepithelial lesion, 1 case (1.8%) ovary cancer, and 1 case (1.8%) metastatic adenocarcinoma. Lesions by site were as follows: cervix, 50% (9/18); endometrium, 38.9% (7/18); ovary, 5.6% (1/18); and other, 5.6% (1/18). Of the 18 clinically significant findings, 3 (16.7%) were of squamous origin and 15 (83.3%) were of glandular origin.
Table 1. Methods of histologic evaluation Methods
No. of patients (%)
p-Bx* + EMBx** + ECC*** + LEEP**** p-Bx + EMBx + ECC p-Bx + EMBx + LEEP p-Bx + EMBx p-Bx + ECC EMBx + ECC p-Bx only EM Bx only ECC only LEEP only Operation Total *p-Bx: colposcopy directed punch biopsy **EMBx: endometrial biopsy ***ECC: endocervical biopsy ****LEEP: loop electrosurgical excision procedure
437
3 (5.3%) 21 (36.8%) 1 (1.8%) 8 (14.0%) 3 (5.3%) 4 (7.0%) 7 (12.3%) 6 (10.5%) 1 (1.8%) 1 (1.8%) 2 (3.5%) 57 (100%)