8
Benign Proliferative Reactions, Intraepithelial Neoplasia, and Invasive cancer of the Uterine cervix
Fig. 8.75 Severe dysplasia. Irregular arrangement of abnormal squamous
cells in the most superficial layers (H&E x HP).
spontaneously and the median duration of progression time to
a more severe lesion, patients with initial diagnoses of mild and
moderate dysplasias should be monitored by regular cytologic
smears for various periods of time before further therapy is rec-
ommended. Only after persistence of the lesion has been con-
firmed are further follow-up procedures, including colposcopy,
warranted.
A cytologic diagnosis of severe dysplasia or carcinoma in situ
is usually followed by colposcopy and biopsy, which at confir-
mation of the process are followed by deep excision, cryocautery,
laser treatment, conization, or hysterectomy.
Follow-up Interval
There is no unanimity about when and to what extent follow-up
examinations of cytologically diagnosed cervical abnormalities
should be carried out.21,120-124 In cases of minimal epithelial
abnormalities, a repeat smear should be advised after 12
months. In cases consistent with mild-to-moderate dysplasia, a
repeat smear after 3 months should be recommended. When the
abnormality is also diagnosed in the repeat smear, the patient
should be referred for further evaluation including colposcopy.
This should also be the procedure when a more severe lesion is
diagnosed in the repeat smear. When the lesion is not confirmed
Fig. 8.76 Dysplasia. Cells desquamating from the superficial layers reflect
the lack of maturation and the grade of abnormality of the epithelial lesion
(H&E x HP).
in the repeat smear, a second repeat smear should be made again
after 3 months. If the lesion remains absent or appears to be of
less severity, the follow-up interval can be doubled to 6 months
and later to 12 months.
It is well known that initial findings of mild-to-moderate
atypia at follow-up sometimes prove to be of a more serious
kind.77,125-128 With a follow-up procedure as described, it is
therefore mandatory that the execution of repeat examinations
be well supervised by the laboratory. Only when this condition
is fulfilled is an initial cytologic follow-up of mild-to-moderate
abnormalities warranted.21
The procedure described has been adopted for the nation-
wide screening program in the Netherlands.21,121,129 In cases of
cytologic diagnoses consistent with mild dysplasia or a more
severe lesion detected outside the screening program, an imme-
diate referral for colposcopic evaluation is agreed on by all
parties involved.
Colposcopy
The colposcope is well suited for follow-up studies of CIN
because of its lack of influence on the natural history of the
disease.22 An optimal cancer detection system for preclini-
cal asymptomatic cervical lesions should combine a cytologic
examination with a colposcopic follow-up examination. The
169
previous page 170 ComprehensiveCytopathology 1104p 2008 read online next page 172 ComprehensiveCytopathology 1104p 2008 read online Home Toggle text on/off