Cytological differential diagnostic accuracy in severe dysplasia and carcinoma in situ of the cervix and possible clinical consequences (author's transl)

Since 1943 when Papanicolaou introduced cytology into gynecology the method has changed from a simple screening test into a sophisticated morphologic technique, the differential cytology. In Germany this development is documented by an improved cytologic classification (Münchner Nomenklatur). An own material is presented consisting of 520 cases of histologically proven severe dysplasias and in situ carcinomas. It can be shown that careful and critical use of differential cytology with due regard to its limits can improve the accuracy of the cytologic prediction of a cervical lesion. A delineation against invasive cancer is possible with a hundred percent accuracy. On the basis of these results it seems justifiable to perform a primary hysterectomy without pretherapeutic cone-biopsy. It is pointed out that this procedure is only possible in institutions were the possibilities of differential cytology are well-known and--which is more important--where the limits of the method are known and respected. In any case of doubt the procedure of diagnosis and therapy has to be discussed and planned in close cooperation between the clinicians and the morphologists.