PART TWO
Diagnostic Cytology
The stimulus that has induced a proliferation of reserve cells
as such also blocks the differentiation of these reserve cells into
immature and then mature squamous metaplastic cells.
Depending on the strength of the negative stimulus on the
ectocervical squamous basal cells and endocervical reserve cells,
and in a later stage, immature metaplastic cells, the ultimately
resulting epithelial lining cells have a more or less differenti-
ated appearance. This explains not only common morphologic
features in the different variants of dysplasia and ultimately in
the most dedifferentiated intraepithelial variant, carcinoma in
situ, but also the extremely common co-occurrence of carci-
noma in situ and dysplastic changes of different severity.
It is well known that the majority of cervical epithelial abnor-
malities regress to a less abnormal change after a variable time.
In this respect, it is justified to monitor these changes cytologi-
cally, when the cytodiagnostic service is of high quality.
Although it is not usually possible to predict the malignant
potential of an epithelial abnormality (premalignant lesion) on
a purely morphologic basis, evidence suggests that mild dyspla-
sias are more prone to regress spontaneously, and conversely,
severe dysplasia and carcinoma in situ are more likely to persist
or progress.
Microinvasive carcinoma is the earliest stage in the genesis
of an invasive cancer that can be recognized cytologically and
histologically. The negative field stimulus described above
also apparently influences the columnar epithelium of the
endocervical canal. The co-occurrence of abnormal columnar
cell changes together with abnormalities of the squamous and
squamous metaplastic epithelium is becoming increasingly fre-
quent.
The cytology report should consist of a concise description
of abnormal cellular findings in well-defined and generally
accepted terms, followed if appropriate by a prediction of the
histologic condition. It should also include a recommendation
for the further treatment of the patient. Where possible, the
classification should relate to the biologic significance or poten-
tial of the process.
The cytologic report should thus encompass the following
items:
• A statement about the adequacy of the specimen,
including an explanation of the problems encountered
for less than fully satisfactory specimens and a deter-
mination of whether a repeat specimen is necessary;
• A descriptive diagnosis comprising the presence and
character of any inflammatory changes, the expected
histopathologic change in the squamous or squamous
metaplastic cervical mucosa, and changes in columnar
cells from the endocervical mucosa or an abnormality
related to the endometrium; and
• A recommendation for further action to be taken on
the basis of the cytologic diagnosis.
The reduction in the incidence of squamous cell carcinoma
of the uterine cervix and mortality from cervical cancer is a
result of cytological screening and the subsequent detection and
removal of precursor lesions. The diagnosis of cervical glandular
cell lesions or combined squamoglandular cell lesions is based
on the same cytological principles.
Diagnostic cytology of the uterine cervix is the most wide-
spread and best known application of cytology in clinical diag-
nosis of diseases. Mortality due to cervical cancer has declined
significantly during the past decades because of the widespread
use of preventive cervical cytologic screening.
Despite a relatively high proportion of incorrect diagnoses
in large-scale population-screening programs, cervical cytology
has been proven to be the most effective tool for the diagnosis of
cervical cancer, primarily because of the frequency of testing and
the long precancerous stages of the disease prior to development
of invasive carcinoma.
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