Hi, All. Please offer any and all expertise, please please please. I am generally very healthy, 37, married, 2 healthy kids, one baby loss to anencephaly, non-smoker, non-drinker, eat healthy, exercise, could lose a few pounds, had 2 laparoscopies for ovarian cysts (one in teen years, one in my 30's) and HPV negative.
My new/current OB/GYN and her staff were very critical that I was googling and trying to make sense of my latest pap results. I'm not terribly confident in her medical practice (although the group of docs came recommended). Sigh. This doc is new to me as we recently moved to a new city/state.
For the last 3 years, I have alternated between normal and abnormal paps...my prior doc always labeled/explained the results as "atypia." She never seemed concerned since I never had two back-to-back abnormal paps (she was testing me every 6 months). She last saw me 9 months ago, before our move, and my resluts were abnormal (atypia again). She directed me to come back in 6 months.
Due to our move, 9 months have passed. I went to this new doc in our new state for a pap. I got abnormal results 2 weeks ago. This is my first back-to-back abnormal test. The nurse told me I have two types of abnormal cells...the ACUS and AGUS. Never having heard of glandular cells on a cervix, I began my search to understand exactly what is going on in my body.
Yesterday, I had a colposcopy. She took cervical biospies at 7, 10, and 1 o'clock. She also did an endometrial biopsy. She said through her visual examination, she thought I had mild dsyplasia. She said she'd call me with the path. results in about a week to week and a half.
Is snipping cervical flesh different than the ECC you all praise?
I was on Day 5 of my period (wore a tampon on Day 4). I only needed a panty liner on Day 5. I called old OB-GYN's nurse and she said that their practice would consider the AGUS as perhaps being read on the pap due to being on my period at the time of the pap. My new OB-GYN said "no" and that there was no mention in the pap report of too many red blood cells and she felt my period had nothing to do with the AGUS. I hate it when two docs have two totally different perspectives. GRRRRR.
Where do I go from here? Any help is soooo appreciated. Waiting is hard.
Blessings to you all and thanks for being such a wealth of information.
An ECC is not the same thing as a colposcopy. An ECC is an endocervical curettage and it takes tissue samples from higher up in the cervical canal. If you have an AGUS (atypical glandular cells of unknown significance) in addition to an ASCUS (atypical squamous cells of unknown significance) finding then your doctor should be performing an ECC in addition to the colposcopy.
A colposcopy takes tissue samples of areas which turn white when the cervix is subjected to a certain substance that shows up the atypical cells. The atypical cells are then examined to see what they are. An endocervical curettage takes random samples from much higher up the cervical canal. This is necessary because atypical glandular cells will not necessarily be visible like squamous cells are.
Keep in mind that this is not cause to panic, especially if you seem to have had atypical cells on a regular basis all of your life. However, in order to rule out any serious causes of the atypical cells, you need to insist on an ECC. See what your doctor says about this.
Hopefully, someone with more experience than I in these matters will also be able to give you more information than I. Don't panic until there is cause to panic but at the same time, make sure that you have ALL of the necessary tests to rule things out so that you can be sure that all of your bases are covered.
I wish wish wish I had read about the ECC prior to yesterday's colposcopy. The OB/GYN didn't really like all my questions...seemed irritated with me. I don't think she did an ECC. Maybe I'll call the office and confirm one way or the other....I'm pretty sure she just took the 3 snips from the cervix and the endometrium biopsy.
I also realized that I forgot to address your concerns regarding the disagreement between your new and your old gyne.
It seems that a pap smear taken during your period may turn up some endometrial cells which, I believe, are glandular. This is not surprising since you are shedding your endometrial lining at this time. However, these cells should not turn up as atypical as far as I know. They should simply show up as normal glandular cells which would normally not be on a pap smear. Hopefully a lab would know the difference between normal glandular cells appearing on a smear which may be due to active menstruation and atypical glandular cells.
This is perhaps where the confusion lies. I would definitely request that ECC to make sure they have everything covered. Then you will not have to worry about who is right and who isn't.
Just called the office and spoke with the nurse present during the procedure. The doc did not do an ECC. The nurse said she did not do it b/c the endometrial biopsy is two procedures in one...she can get a canal sample on the way out of the endometrial biopsy.
Opinons on that?
Last edited by dlittle; 09-24-2009 at 10:38 AM.
This is quite possible as she has to go through the canal to get the endometrial sample. However, I was under the impression that for the endo biopsy they simply insert a type of straw and twirl it around while suctioning in order to get the sample. For the ECC they have to actually scrape the canal. It is very possible that your doctor did both in one procedure as she may have clamped the cervix open. Perhaps other ladies on these boards have more info on the ECC procedure (I have only ever had an endometrial biopsy).
Oh the and reason AGUS appears on the pap is because if there is a lesion related to this finding, it is often near the external os and not higher up in the canal. This means that usually the abnormal cells are further down the cervical canal.
When you receive the report, you should be able to see if the doctor took an endocervical sampling along with the endometrial biopsy (it should say) so you will know for sure.
I wish you the best and I will be praying for good news for you.
Estria has given you some good advice, and here's my two cents on the matter. FYI, I have had a colpo w/biopsies, endometrial biopsy and an ECC (as well as further treatment).
I have never heard of an endometrial biopsy also being sufficient for diagnosing cervical glandular problems. Yes, it is possible to get contamination from the cervix in the endometrial biopsy sample, but that is a hit or miss, and definitely NOT the standard for obtaining an actual sample of cervical glandular tissue. That is the job of an ECC. Also, if you had the two procedures in one, I think you would have noticed having the ECC, as it is a definite pinch, as opposed to the pressure/discomfort of the uterine biopsy.
When I had my colpo, my doc took two pinch/punch biopsies (which take very small pieces of the outer cervix), which is what it sounds like your doctor did. I also had an ECC, which was a second procedure, but was definitely something you can't miss! He said it would pinch, and it did, but by the time I could think wow, that hurt, it was over...but you definitely feel it (although don't be scared, for me it was really not that bad, and the pain did not linger!). The ECC, at least in my case, took a 1cm wide by 1cm long by 1mm thick piece of tissue. Anything that could/would be gotten in an endometrial biopsy would be scanty cells at best, since the most you would get is what's scraped on the way in/out of the uterus. The ECC takes actual cervical glandular tissue, and is the best way to figure on what's going on up there, although even that is hit or miss. For example, my ECC was totally clean, even though at the time I had invasive adenocarcinoma -- it's just that my ECC sampled a portion of cervix that wasn't infected. "Luckily" my pinch biopsies discovered the problem and I was able to be treated and am today thankfully cancer free
I believe Estria is right, that any glandular cells present in your pap because of your period would not show up as AGUS. As a matter of fact, a good pap should note that there are endocervical cells present, because that means they got a sample of those cells and that they were fine (assuming the pap is normal, that is). If you are showing AGUS cells, then there is most likely something that needs exploring -- but that doesn't mean to panic!!! There are plenty of reasons why something could come up abnormal, that have nothing to do with an indication of a major problem.
I know the waiting for test results stinks....and this is easier to say than do, but try not to dwell on it or get too nervous about it. I know you will anyway; we all do!! That's totally normal.
If you don't like the attitude of your new doc, then find another one! Unfortunately, many of us have had not so great experiences with our gyns...and sadly, it seems that at best it's 50/50 as to whether you can find one you like. Don't feel like it is you, or that you need to put up with that treatment. In my experience, any doc who is "annoyed" that you have done your research and are asking questions needs to be avoided. You'd think they'd be happy to have a well-informed, concerned patient, but a lot of them seem to get almost offended that you dare to question their judgment. As someone who completely trusted my old ob-gyn, only to find out that she dropped the ball on me, didn't do good pap smears for almost ten years, and was not up on her stuff regarding cervical cancer, I cannot urge you enough to question your doc if you are uncomfortable/unhappy/distrustful of what they tell you. I so wish I had been more firm with my old doctor. I hate her
I hope some of this helps! And please let us know how your test results go.