After colposcopy with endocervical curettage in a patient with Pap showing atypical glandular cells, what can be considered as the next step?

• A. Hysteroscopy
• B. MRI pelvis
• C. Laparoscopy
• D. Repeat ECC

Answer: (A)

Atypical glandular cells on a Pap test raise concern for possible endometrial or endocervical glandular pathology, including early endometrial cancer or hyperplasia. Endocervical sampling with ECC focuses on the canal, but it may miss lesions within the endometrial cavity itself. Because glandular abnormalities can originate in the uterus, the next step should allow direct inspection of the endometrial lining and obtain targeted tissue samples.

Hysteroscopy provides a direct view of the uterine cavity and endocervix, enabling you to identify focal lesions and perform directed biopsies or resections. This approach offers the most definitive assessment of where a glandular abnormality originates when Pap shows atypical glandular cells, guiding further management.

MRI pelvis and laparoscopy have roles in staging and broader pelvic evaluation once cancer is confirmed or strongly suspected, but they’re not the immediate next step after an AGC finding with prior ECC. Repeating ECC alone is unlikely to add diagnostic clarity in this context.