PART TWO
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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