The Challenge of Pathological Diagnosis for Precancerous Cervical Lesions

Year 2019, Volume: 5 Issue: 1, 39 - 45, 28.04.2019

İlkay Cinar

https://doi.org/10.19127/mbsjohs.521193

Cited By: 2

Abstract

Cervical cancer is the third most common
cancer after breast and colorectal cancers worldwide, and the second most
common gynecological malignancy after endometrial cancer. Cervical cancer screening was first described by
Papanicolaou in 1941 using the PAP smear test. The incidence of invasive
cervical cancer clearly reduced with the common use of PAP smear in developed
countries. The basic methods used for diagnosis of premalignant lesions
of the cervix are determination with colposcopy, biopsy and HPV DNA typing.
Cervical premalignant lesions cannot be observed with the naked eye, other than
exophytic or papillary lesions of condyloma acuminatum. Condyloma acuminatum
are simultaneously LSIL. LSIL and HSIL differentiation cannot be made with
colposcopy. Due to better repeatability and interobserver compliance, the World
Health Organization (WHO) recommends a 2-layer HSIL/LSIL system. In the 3-layer
CIN system, CIN1 is equivalent to LSIL, while CIN3 equivalent is HSIL. The
lesions are frequently encountered in routine biopsies, and in some cases,
differential diagnosis may be difficult. Basal cell hyperplasia, atrophy,
reactive and repair-induced atypia and immature squamous metaplasia may mimic
precancerous lesions. Although histomorphology is gold standard, P16 and Ki-67
are beneficial immunohistochemical ancillary testes. However, it should be kept
in mind that p16 can be positive in LSIL, and negative in HSIL.

Keywords

Cervix, premalignant lesions, pathology

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