The appropriateness of examining the entire cervix histologically in hysterectomy specimens from women with a previous history of cervical intraepithelial neoplasia or dyskaryosis

Abstract

Background/Aims-To investigate the necessity of examining the entire cervix in hysterectomy specimens from women with a previous history of cervical intraepithelial neoplasia (CIN) or dyskaryosis. Methods-The overall frequency with which squamous CIN was encountered in hysterectomy specimens of women with a previous diagnosis of squamous CIN or dyskaryosis was calculated in a sample of 71 women. The frequencies in women with positive or negative smears or biopsies between the initial diagnosis and hysterectomy, and in women with no intervening smear or biopsy, were also estimated. Results-A persistent CIN lesion was identified in 18 patients (13 high grade cases; five low grade cases). A further eight patients who had high grade CIN also had microinvasive disease (seven cases of FIGO stage 1a1; one case of FIGO stage 1a2). Ten of the 20 patients with a positive smear or biopsy, but none of the 16 patients with a negative smear or biopsy between initial diagnosis and hysterectomy, had an abnormality on the hysterectomy specimen. Sixteen of the 35 patients who did not have an interim smear or biopsy had CIN in the hysterectomy cervix. Conclusions-These results support continuing the practice of examining the entire cervix in hysterectomy specimens from women with a previous cervical abnormality, regardless of its histological or cytological grade, if there has been a positive interim smear or biopsy or if neither investigation has been performed. (J Clin Pathol 2001;54:155-157)

Comparison of examination of the entire uterine cervix with routine cervical sampling in hysterectomy specimens from women with endometrial cancer: Table 1

“…Hence variation between pathologists and potentially wasted effort and resources may be widespread. Evidence exists about the sampling of the cervix in hysterectomies following a previous diagnosis of cervical intraepithelial neoplasia,6 but we have been unable to identify similar evidence for the staging of endometrial cancer. It is likely that involvement of the cervix by endometrial adenocarcinoma is by direct spread or by implantation 7.…”

“…The pathology guidelines for how to assess cervical involvement in such cases are outlined in peer produced and assessed protocols,4 5 but the evidence base for these with respect to how a histopathologist should sample the cervix is difficult to find, if indeed it exists. Green and Heatley6 investigated hysterectomies from women with a history of previous cervical abnormalities; routine cervical sampling with one block from the anterior and one from the posterior cervix was sufficient to ensure that potentially significant pathology was not missed, although in some circumstances more extensive sampling of the cervix may be appropriate. Whether these results can be extrapolated to non-benign hysterectomies is unknown.…”

Dissection and reporting of the organs of the female genital tract

“…A less extensive sampling procedure has been advocated in patients with a history of a CIN lesion if intervening smears or biopsies are negative,71 and a previous small study would seem to provide some support for limiting the examination to sections that demonstrate the epithelium lining the canal and lower segment 68…”