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Presented by Dr. J. Thomas Cox, MD
Release Date of Activity: November 2009
Expiration Date of Activity for AMA PRA Credit: November 30, 2012
Estimated Time to Complete This Activity: 1 hour
Authors and Reviewers Biosketches |
To register for the Online CME Series click here
Course Summary and Competency Goals
This lecture will provide a broad, evidence-based understanding of the best management options for women with the Pap interpretation of atypical glandular cells (AGC).
Atypical glandular cells or AGC, may be the most difficult diagnostic challenge of any of the abnormal Pap categories devised under The Bethesda System (TBS). The Pap interpretation of AGC is meant to describe cellular changes in glandular cells that exceed those expected in a benign reactive or reparative process yet are not abnormal enough to be clearly neoplastic. Although AGC once shared the "of undetermined significance" qualifier with atypical squamous cells of undetermined significance (ASCUS), the similarity ends there. AGC represents a much greater risk for cervical precancer and cancer than atypical squamous cells (ASC) or low-grade squamous intraepithelial lesion (LSIL). Both high-grade squamous (cervical intraepithelial neoplasia [CIN 2,3]) and glandular cervical epithelial abnormalities (adenocarcinoma in situ [AIS]), as well as cervical and endometrial cancers may be found in the follow-up to an AGC Pap result, and many of these serious lesions are found at much higher rates than with any other Pap reading other than HSIL and cancer. The AGC Guidelines discussed here were first developed at the ASCCP National Consensus Conference for the Management of Women with Cervical Cytological Abnormalities and Cervical Cancer Precursors, at the National Institutes of Health in 2001 and updated at the 2006 ASCCP Consensus Conference. This development of consensus-approved guidelines is considered the most important milestone to date in the management of women with abnormal cervical cytology. This presentation will discuss the guidelines and the supporting data for both the initial and the post-colposcopy management of women with atypical glandular cells.
This evidence-based online activity was specifically designed to improve patient care, medical knowledge, practice-based learning, and systems-based practice gaps.
Learning Objectives
Upon completion of the learning activity and its post-test, participants should be able to:
- describe the Bethesda 2001 terminology subcategories for atypical glandular cells;
- determine the best initial management option for women with AGC cytology results;
- determine the best post-colposcopy management option for women referred to colposcopy for the evaluation of AGC cytology;
- describe the data from studies that provide the evidence supporting the AGC guideline recommendations; and,
- determine the best management options for women with the histologic diagnosis of adenocarcinoma in-situ (AIS).
Intended Audience
The target audience of the Online CME lecture "The ASCCP Guidelines for Managing AGC" is all clinicians who interpret the results of cervical cancer screening tests and those who diagnose, observe, and treat preinvasive disease. This activity was designed to meet the CME needs of the practicing obstetrician-gynecologist, family physician, gynecologic oncologist, pathologist, obstetrics/gynecology or family medicine resident, nurse practitioner, certified nurse midwife, and physician's assistant.
Accreditation Statement
The American Society for Colposcopy and Cervical Pathology (ASCCP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians.
Continuing Medical Education (CME) Credit
The ASCCP designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Management of Conflicts of Interest and Contributed Funds
As an accredited provider of CME credit, ASCCP is required to comply with the ACCME's Standards for Commercial Support and has implemented a management process to ensure that anyone who is in a position to affect the content of the educational activity (e.g., faculty, planners, etc.) has disclosed to us all relevant financial relationships with any commercial interest and has ensured that those relationships do not influence presentation materials. All faculty have agreed to base their presentations on best available evidence. ASCCP discloses to learners any financial relationship(s) to healthcare-related commercial interests existing within the past 12 months to include the following information: 1) the name of the individual; 2) the name of the commercial interest; and, 3) the nature of the relationship the person has with each commercial interest. Slides and slide notes are reviewed for possible bias prior to the activity's release by the Accreditation Committee and peer-reviewers, and potential conflicts of interest are resolved prior to the live presentation. Any discussion of off-label use of products is noted when appropriate, as is discussion of any limitations on the information that is presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion. Disclosures of these commitments and/or relationships are published in these lecture materials and provided prior to the start of the activity, so the learners may formulate their own judgments regarding the presentation(s). Under ASCCP policy, anyone declining either to disclose or amend material to eliminate potential bias identified by the Accreditation Committee will be replaced.
Author, Reviewers, and Planners' Disclosure Information
The following are all reported disclosures of interest or potential conflicts from the 12 months preceding this activity:
J. Thomas Cox, MD (Author) - serves on the Data and Safety Monitoring Board for Merck & Co and receives a fee for his service. He is also a scientific advisory board member for Gen-Probe and an advisory board member for Abbott, for both of which he receives an honorarium.
Charles J. Dunton, MD (ASCCP Program Committee Chair/CME Reviewer) - serves on the speakers' bureaus of Merck & Co, GlaxoSmithKline, and Qiagen and receives honoraria. He also serves on an advisory board for Nycomed and receives an honorarium.
Hope K. Haefner, MD (CME Reviewer) - served on the speakers' bureau for Merck & Co and receives an honoraria. Effective March 2010 forward, she has had no financial relationships or conflicts to disclose.
Beth Colvin Huff, MSN, NP (CME Reviewer) - is a shareholder, receiving dividends with Hologic and serves on the speakers' bureaus of Merck & Co and Qiagen, for which she receives honoraria.
Mark Spitzer, MD (CME Reviewer) - serves on the advisory boards for Merck & Co and CytoCore and for which he receives honoraria. He also serves on the speakers' bureau for Merck & Co and receives honorarium. He is a book author and a shareholder of the SABK Corporation and serves as a book editor for Elsevier for which he receives a royalty for services.
Those reporting no financial relationships or conflict of interest to disclose:
L. Stewart Massad, MD (Accreditation Committee Co-chair/CME Reviewer/Planner)
Herschel W. Lawson, MD (CME Reviewe/Accreditation Committee Co-chair)
Kathleen Poole (ASCCP Executive Director, Planner)
Carol Noonan (ASCCP Assistant Course Administrator, Planner)
CME Inquiries
For all CME certificate inquiries, please contact Ms. Carol Noonan at cnoonan@asccp.org or by mail at the ASCCP National Office, 152 West Washington Street, Hagerstown, MD 21740 or by phone at 301-733-3640.
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