Cervical Epithelial Abnormalities Research Articles

Gynecologic disease in young, sexually active women

There has been a significant change in adolescent sexual behavior in the past decade. This report of 1,594 young, sexually active women, primarily from middle and upper socioeconomic backgrounds, identifies the obstetric and gynecologic problems characteristic of the group. While supposedly in a low-risk category these patients displayed a high incidence of cervical epithelial abnormality, problem pregnancy, and other obstetric and gynecologic abnormality. The incidence of veneral disease was somewhat lower than anticipated.

Dysplasia and carcinoma in situ of the uterine cervix: Prevalence in very young women (under age 22): A one-year study in a health plan population

An increased number of cervical epithelial abnormalities has been observed in women up to and including 21 years of age. The prevalence and incidence of dysplasia in adolescents and young women is increasing at a time when the incidence of cervical carcinoma is decreasing. We studied 247 women under age 22 with "other than negative" cytologic diagnoses identified during a one-year period (1973) in which approximately 27,500 women in this age group were screened. The prevalence rates of "other than negative" cytology and "other than negative" cytology with confirmed histopathologic abnormalities were 9/1,000 and 2.7/1,000, respectively. Repeat smears and/or tissue speciments were obtained in over 70 per cent of these cases. The majority of abnormalities identified were mild or moderate dysplasia; however eight severe dysplasias and three carcinomas in situ were identified. Fifty-nine percent of these women had a history of one or more pregnancies. Our findings emphasize the presence of dysplasia and carcinoma in situ in young women and suggest the need for re-evaluation of the age at which initiation of the Papanicolaou smear should be considered.

Reliability of the cervical cytologic smear as a screening procedure in patients undergoing gynecologic surgery for benign disease

From 1966 to 1970, hysterectomy was performed on 845 patients with normal Papanicolaou (“Pap.”) smears at the University of Kentucky Medical Center. Histologic examination of the hysterectomy specimens revealed four cases of undiagnosed carcinoma in situ of the cervix. During this time period, there were 210 patients with a tissue diagnosis of severe cervical dysplasia, 331 patients with carcinoma in situ of the cervix, 23 patients with Stage IA-1 invasive cervical cancer, and 30 patients with Stage IA-2 invasive cervical cancer. No patient had microinvasive or invasive cervical cancer in the absence of a cervical lesion which was not detected by Pap. smear. These data indicate that the Pap. smear is an effective screening technique in the diagnosis of cervical epithelial abnormality.

Consistency in the histological diagnosis of epithelial abnormalities of the cervix uteri.

A group of pathologists, all working in the same laboratory and all applying the same diagnostic criteria to the diagnosis of epithelial abnormalities in the uterine cervix, have studied the consistency with which they have applied these criteria. Epithelial abnormalities were ranked, and a series of sections were diagnosed separately by each pathologist at various times over a number of years. Both consistency and trend were studied by a graphed statistical method and it was shown that not only were there serious inconsistencies in diagnosis between the various pathologists but also between the diagnoses made by individual pathologists studying the same section at various times. It is suggested that this inconsistency in the application of agreed diagnostic criteria is of importance when considering discrepancies between reported series of cervical epithelial abnormalities and that the type of study described is of value in assessing both variations in diagnostic criteria between different laboratories and the consistency of pathologists in training. Any slight change in the application of diagnostic criteria for any individual pathologist with the passage of time may also be detected by this technique.

Cone Biopsy of the Cervix

Summary The procedure of cone biopsy of the cervix is described. Its efficacy as a method of diagnosis of cervical epithelial abnormalities and its possible place as a method of treatment are discussed and the literature is reviewed. A series of 30 cases is presented and analysed.

Follow-up on cervical epithelial abnormalities

T HE concept of preinvasive squamous-cell carcinoma of the cervix has become firmly established in recent years though the criteria for the diagnosis of this lesion vary somewhat from person to person and place to place. The widespread interest in this lesion plus the increased use of vaginal and cervical smears as a screening procedure have made it evident that there is a whole spectrum of lesser abnormalities which lie in the continuum between normal epithelium and preinvasive carcinoma. It has been suggested that these changes may represent steps in a progression from the normal to preinvasive carcinoma. These lesions have been variously designated as anaplasia, atypical hyperplasia of the stratified squamous epithclium, basal-cell hyperplasia, and by many other terms. We have used two terms to describe these abnormalitics: atypical basal-cell hyperplasia and equivocal lesion. The latter term is used by us when abnormalities extend throughout the full thickness of the epithelium but are inadequate t,o justify the diagnosis of preinvasive carcinoma. The former is reserved for instances where such abnormalities are restricted to the lower one half to two thirds of the epithelium. the superficial layers remaining normal.