CERVICAL AND VAGINAL CYTOLOGIC SMEARS SUGGESTIVE OF ADENOCARCINOMA

OBJECTIVE: To determine the appropriate evaluation of women with cervi cal cytologic smears suggestive of adenocarcinoma. STUDY DESIGN: Of 1, 192,972 smears obtained between July 1989 and March 1992, 57 (0.005%) were interpreted as adenocarcinoma, adenocarcinoma in situ or ''rule o ut'' adenocarcinoma. Review of medical records allowed the determinati on of pathologic diagnoses in 46 of 57 women. Thirty of the 46 cytolog ic smears were reviewed. RESULTS: Fifteen of the 46 women were premeno pausal and < 50 years of age. Twenty-three were asymptomatic, 22 had a bnormal vaginal bleeding, and I had increasing abdominal girth. Twenty -nine (63%) of the 46 women had cancer, 12 (26%) had cervical intraepi thelial neoplasia 2 (GIN 2) or 3, and 5 (11%) had CIN 1, condyloma or no pathology. Of the 29 women with cancer, 11 had cervical cancer, I h ad vaginal cancer, 13 had uterine cancer, and 4 had extrauterine cance r. Nineteen or 22 women (86%) with abnormal vaginal bleeding had cance r; 9 of 23 asymptomatic women had cancer (39%) (chi(2) = 9.84, P < .01 ). DISCUSSION Women with smears suggestive of adenocarcinoma require b iopsy of cervical or vaginal masses, colposcopy with directed biopsy, endocervical curettage and endometrial biopsy. If cancer is not diagno sed, cervical conization with dilatation and curettage (D&C) is indica ted. If conization with D&C is negative, laparoscopy is indicated to e xclude extrauterine cancer.