Vesna Mahovlić

Cytology of Cervical Intraepithelial Glandular Lesions

Cytological criteria for the identification of glandular intraepithelial lesions (GIL) have not yet been fully described, especially for the precursors of adenocarcinoma in situ (AIS), thus these lesions may frequently remain unrecognized. As most patients diagnosed with AIS or mild to moderate GIL (grades I, II) are free from clinical symptoms, cytology has a very responsible role in the detection of these lesions. The aim of the study was to achieve the most appropriate cytologic diagnosis of intraepithelial lesions of endocervical columnar epithelium, analyzing the cytology findings in patients with histologically verified AIS and GIL (I, II). The value of cytology in the detection and differential diagnosis was assessed in 123 patients with definitive histologic diagnosis of glandular lesions (AIS, n = 13; GIL I, n = 11; and GIL II, n = 7), and glandular lesions associated with squamous component (AIS associated with cervical intraepithelial neoplasia (CIN) or invasive squamous cell carcinoma (SCC), n = 58; GIL I or GIL II associated with CIN, n = 28; and GIL associated with microinvasive squamous carcinoma (MIC), n = 6). In 95.1% of patients, lesions were detected by cytologic analysis that indicated additional diagnostic procedure. In terms of differential diagnosis, cytology showed higher accuracy in predicting lesion severity vs. type of epithelial alteration (75.6% vs. 55.3%) and abnormalities of columnar epithelium (95.7%; vs. 74.2%). The accuracy of cytology was higher in pure (AIS, 61.5% and GIL I, II, 22.2%) than in mixed lesions (25.9% and 20.6%). Continuous improvement in cervical specimens and cytodiagnostic skills, better understanding of intraepithelial adenocarcinoma and precursors, and their inclusion in the classification of cytologic and histologic findings are expected to upgrade the detection of these lesions, and to reduce the invasive cervical adenocarcinoma morbidity and mortality.

The Value of HPV-HR DNA Testing During the Follow-Up After Treatment of CIN3/AIS

Up to 30 % of women treated for a preinvasive cervical disease are diagnosed with a residual/recurrent disease including an invasive carcinoma during follow-up. Studies have shown a higher sensitivity in detection of residual/recurrent disease with the use of combined testing (cytology and HPV. One hundred and thirty five patients treated with cold-knife conization (CKC) or large loop excision of the transformation zone (LLETZ) for a preinvasive cervical disease, were enrolled in the study. The follow-up consisted of cytology, colposcopy with biopsy if needed and HPV testing. Only patients with at least two cytology smears and one HPV test during the first two post-treatment years remained in the study. The HPV test was performed by EIA PCR and by Line immuno Probe Assay. The statistic analysis was performed using the χ2 test. Results of our study suggest that in our setting the best approach is to have a first control cytology smear 6 months after conization. HPV test should be done in patients with a positive smear any time during follow-up as the point of decision for a second treatment. With this approach we could considerably decrease the number of reoperated patients and co-morbidities without decreasing the quality of follow-up.