Diagnostic Cytology
Fig. 8.72 Severe dysplasia. Cells and nuclei are irregularly shaped.
Finely granular and coarse, moderately hyperchromatic nuclear chromatin
(Papanicolaou x OI).
patients entered in the study were highly selected: One of the
criteria for acceptance was persistence of the lesion for at least
a three-smear interval. This eliminated many lesions owing to
repair and other processes that cytomorphologically cannot
be discriminated from dysplasia and that had regressed during
the interval.
Bamford and co-workers reviewed the smears preceding the
histologic diagnosis in 100 cases of CIN grade 3 diagnosed in an
intensively screened population.119 These suggest that the transi-
tion time from normality to CIN grade 3 may be shorter than
has generally been assumed. However, they provide no informa-
tion about the quality and cellular composition of the smears
that were reviewed.
Cytologic Follow-up
Given a correct cytologic diagnosis, we do not consider it nec-
essary to perform immediate biopsy on lesions of minimal or
moderate severity, because only a small proportion of these
lesions will progress to a more marked abnormality, whereas
the time required for a lesion to evolve provides ample time
to detect a lesion at successive cytologic examinations. In
view of the relatively large proportion of lesions that regress
Fig. 8.73 Severe dysplasia. Large, elongated cell with relatively
large nucleus and dense, hyperchromatic nuclear chromatin
(Papanicolaou x OI).
Fig. 8.74 Severe dysplasia. Singly lying cells and cells in a syncytial
aggregate with indistinct cell borders and irregularly shaped hyperchromatic
nuclei (Papanicolaou x OI).
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