Gerald A. Galvin

The present-day status of noninvasive cervical carcinoma

Abstract Four years ago we 1 presented before this Society a paper which concerned itself with the minimal histologic changes in the cervical biopsy which would justify a diagnosis of carcinoma. Our observations followed those of Schottlander and Kermauner, 2 who noted a thin layer of carcinoma extending over the surface, surrounding advanced cervical cancer. They also followed the epochal work of Schiller, 3, 4 who first conceived the idea that surface carcinoma could be the beginning of invasive cancer. He described many cases without evidence of invasion in which cellular changes in the surface epithelium were found that were identical to those of invasive cancer. When we undertook our study it appeared to us that there was not sufficient evidence in the literature to justify completely the belief that these intraepithelial changes were precursors of invasive cervical carcinoma. To elucidate this point, we made a comparative histologic study of the biopsy specimens showing malignant changes in the surface epithelium and the ultimate specimens of the cervices removed at hysterectomy. The cervices were cut into several blocks and sections made from different levels in a search for evidence of invasion. In fifteen of the sixteen cervices removed, histologic evidence of invasion was found. Since our publication of 1944, we have continued to collect histologic and clinical evidence concerning this subject and it would seem that we have amassed sufficient data to crystallize our ideas on diagnosis and treatment. This paper is presented before this Society to give our conclusions based on a much wider experience and also with the hope of stimulating discussion concerning this subject.

Mistakes in interpretations of intraepithelial carcinoma

Abstract 1.1. Twenty-five cases in which a diagnosis of intraepithelial carcinoma was made by preoperative biopsy but not confirmed by laparotomy have been analyzed for their sources of error. 2.2. The most common mistake leading to premature unnecessary operation has been a misinterpretation of varying degrees of basal-cell hyperactivity for genuine carcinoma in situ. 3.3. Patients suspected of intraepithelial carcinoma should never be treated hastily and all cases should have repeat biopsy confirmation. Possible confusing and mimicking lesions should be ruled out where possible. 4.4. Where biopsies are repeatedly equivocal, sharp conization of the cervix is recommended as a valuable diagnostic adjunct.