Cytologic, Vascular, and Histologic Patterns of Dysplasia, Carcinoma in Situ and Early Invasive Carcinoma of the Cervix.

By Elisabeth Johannisson, Per Kolstad, and Gunnar Soderberg. Acta radiol. Suppl. 258 Paper, Sw. Kr. 40:-. Pp. 136, with 94 figures and 7 tables. Stockholm, Sweden, Acta radiol., 1966. The past two decades have produced a wealth of information in respect to the histopathologic spectrum of cervical lesions: dysplasia, carcinoma in situ, microscopic invasion, invasive carcinoma. This monograph is dedicated to the study of the usefulness of colposcopy in reference to that spectrum. A careful description of all aspects of colposcopy is presented, and its results are contrasted with those of the cytologic examination of vaginal smears and correlated with the eventual histopathologic findings. In total, 425 patients were selected for this study. In all, cytologic examination of vaginal smears and colposcopy were carried out, and in 222, slightly more than half, a histopathologic study was also made. Eleven cases of clinically ostensible carcinoma of the cervix were included. A large section of the monograph is devoted to comparisons of colpophotographs and microphotographs, with an occasional rather remarkable demonstration of the parallelism of the observed atypia of the terminal vascular bed of the cervix with the microscopic atypia of the overlying epithelium. In the demonstrated presence of dysplasia or more advanced lesions, the authors report the same proportion of false positives, of the order of 7 per cent, with colposcopy as with cytologic examination. In their experience, also, the ability to predict the eventual histologic findings is equal for both methods. The authors conclude that colposcopy is a useful tool in the initial evaluation of cervical lesions, resulting in more accurate preliminary diagnosis. However, 10 per cent of the significant lesions eventually found were not seen by colposcopy because of their endocervical situation. The reported proportion of false positives will be considered excessive by devotees of the cytological study; the authors' claims of equal results of colposcopy may be questioned also. The training of personnel in the demanding disciplines of colposcopy and the time required by individual examinations seem to us unwarranted in view of the success already achieved by careful clinical appraisal combined with routine cytologic study followed, when indicated, by judicious biopsy or conization and skillful histopathologic analysis.