A 49-year-old woman has a routine Pap smear reported as atypical glandular cells, favour neoplastic. She is postmenopausal and has no history of cervical dysplasia; HPV testing is negative. What is the MOST appropriate next step?

• A Repeat Pap smear in 12 months
• B Colposcopy with cervical biopsy alone
• C Endometrial sampling combined with colposcopy and endocervical sampling ✓
• D Immediate total hysterectomy

Explanation

Atypical glandular cells in a woman aged 35 or older, or any woman with risk factors for endometrial neoplasia such as postmenopausal status, require evaluation of both the cervix and the endometrium. Guidelines therefore combine colposcopy with directed biopsies, endocervical curettage, and endometrial sampling, since a significant fraction of these smears herald endometrial rather than cervical lesions. Repeat cytology delays diagnosis, hysterectomy is excessive before histology, and colposcopy alone would miss an endometrial primary.

Reference: Berek and Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.