Search

Aim: The purpose of this study is to present alternative diagnostic criteria of colposcopy using new parameters., Methods: Colposcopic photographs were reviewed in 1649 patients from the past 23 years, including 283 benign lesions, 327 low-grade squamous intraepithelial lesions (LSIL; cervical intraepithelial neoplasia 1), 549 high-grade squamous intraepithelial lesions (HSIL; cervical intraepithelial neoplasia 2/3), 78 microinvasive cancers, and 412 invasive cancers. Abnormal colposcopic findings were divided into: minor or major; single, or a combination of two or three findings; and under half or over half circumferential size. Histopathological backgrounds were investigated according to these new parameters of colposcopic findings., Results: Minor abnormal colposcopic findings were observed in 21% of LSIL, and major abnormal findings were seen in 52% of LSIL, 86% of HSIL, and 86% of microinvasions. A single major abnormal finding was observed in 64% of the cases with LSIL, while two abnormal findings were observed in 43% of HSIL, and three abnormal findings were observed in 44% of microinvasions. In qualifying major abnormal colposcopic findings, under half size was detected in 91% of LSIL and 74% of HSIL, and over half size was observed in 58% of microinvasions. From these results, the following diagnostic criteria were instituted: (i) LSIL - single, minor or major findings and under half size; (ii) HSIL - two or three major findings and under half size; (iii) microinvasion - three major findings and over half size; and (iv) invasive cancer - irregular surface with atypical vessels., Conclusion: Our new diagnostic criteria of colposcopy are fully acceptable, based on their similar level of accuracy to cytology., (© 2016 Japan Society of Obstetrics and Gynecology.)

Uterine cervical cancer is the most common primary gynecologic malignant tumor in Japan. Conventional cervical screening Papanicolaou (Pap) test has been shown to be extremely effective in reducing cervical cancer incidence and mortality, but the consultation rate for cancer screening in Japan is markedly low, at 20% of prescribed subjects, in comparison with other developed countries. In 2001, 15,501 women (6.8%) received a Pap test in Kitakyushu City, and that was less than half of national average. From 2009, free coupons for uterine cervical cancer screening were distributed to Japanese woman who were 20, 25, 30, 35 or 40 years of age as part of the project for women-specific cancer screening. The rate of participation in Pap testing was 22.3% in 2012, with 31,970 women receiving cervical tests. It was almost as high as the national level. It's obvious that high risk human papillomavirus (HPV) is responsible for cervical cancer incidence and HPV mainly infects through sexual practice. The rate of early cervical neoplasms and invasive cancers is currently increasing in young women. Abnormal Pap tests were detected in 2.3% of the women in 2008. To increase the population's participation in this screening process, a cost-effective and efficient system should be established. National and local governments, medical institutions, companies, and educational institutions must have an accurate understanding of the current situation, and take an assertive approach in order to decrease the mortality rate of uterine cervical cancer.

Despite the proven effectiveness of cytological uterine cervical cancer screening, the consultation rate for cancer screening in Japan is markedly low in comparison with other developed countries. Although the mortality of this cancer has been steadily decreasing, it has been on the rise in the recent several years. It is evident that human papillomavirus (HPV) is involved in the occurrence of uterine cervical cancer, and, because of changes in sexual awareness and the diversification of sexual behavior, the increase in the incidence of uterine cervical cancer, especially among young adults, has become a major social problem. There is a false negative rate of about 10% in cytological uterine cervical cancer screening, seen mostly in cervical adenocarcinoma cases. As there is a limit to the effectiveness of cancer screening by cytology alone, there is a movement in Japan to increase the accuracy of cytological screening by using liquid-based cytology (LBC) and adopting HPV testing. There are various problems in cytological cancer screening, but the national and local governments, medical institutions, companies, and educational institutions must have an accurate understanding of the current situation and take an assertive approach in order to decrease the mortality rate of uterine cervical cancer.

The purpose of this study is to investigate the side effect in patients who survived for more than 5 years after initial treatment for invasive cervical cancer. Between January 1984 and December 1997, 341 patients underwent primary treatment for invasive cervical cancer. One hundred nine patients who underwent medical examinations at 5 years after primary treatment were reviewed. The patients were divided into three groups: radical surgery alone (group A), radiotherapy alone (group B), and radical surgery with postoperative radiotherapy (group C). Dysuria was seen in 8%, and positive catheterized urine culture was noted in about 20% of groups A and C. Hydronephrosis was seen in 2% and 9% of groups A and B, respectively. Colitis or ulcer detected by proctosigmoidoscopy was noted in 15%, 50%, and 43% of groups A, B, and C, respectively, frequently observed in radiotherapy group (P= 0.0029). Lymphocyst was still present in 6% of group A, and leg edema was noted in 14%, 6%, and 15% of groups A, B, and C, respectively. Long-standing abnormal findings including urinary and bowel complications were presented in this study. Periodic physical examination after treatment should be performed because complications existed over a long time.

Combination chemotherapy with paclitaxel and carboplatin every 4 weeks for 3 cycles was administered for recurrent glassy cell carcinoma of the uterine cervix in a 67-year-old Japanese female. The response rate was 56% under computed tomography (partial response). However, the effect was transient even with follow-up radiotherapy, and further cases need to be accumulated to determine a successful treatment modality.

Background: Cytologic findings of sarcoma botryoides were still equivocal because sarcoma botryoides of the uterine cervix is an extremely rare neoplasm, and few cases have been reported to date., Case: A 17-year-old female was diagnosed with sarcoma botryoides of the uterine cervix. The entire vaginal canal was occupied with polypoid masses, which arose from the anterior lip of the uterine cervix, and the tumor was classified as group I (Intergroup Rhabdomyosarcoma Study). After wedge resection and six courses of combination chemotherapy, the tumor recurred in the same location of the cervix as the primary lesion. Touch smear of the polypoid mass formed loose clusters and also showed short spindle cells in a necrotic background. The nucleus of the tumor cells had a thin nuclear membrane, fine chromatin pattern and partly clear nucleolus, showing mild nuclear atypia. Immunohistochemically, some of the tumor cells showed positive staining for myoglobin and desmin., Conclusion: The cytologic findings of sarcoma botryoides of the female genital tract are typical features of nonepithelial malignant tumor. Immunohistochemical study is useful for the diagnosis of rhabdomyosarcoma.

Objective: To investigate the correlation between the development of low grade cervical intraepithelial neoplasia (LCIN) and human papillomavirus (HPV) infection in cases with long-term follow-up., Study Design: Forty-three cases of LCIN were followed for more than five years with cytology, colposcopy and Vira Pap. Coexistence of HPV infection was sought using a simplified HPV detection kit, the Vira Pap method (Dot Blot hybridization)., Results: Regressive disease was noted in 21 cases, and persistent and progressive disease was noted in 22 cases. HPV DNA was negative in 81% (17 of 21) of regressive disease and positive in 55% (12 of 22) persistent and progressive disease. LCIN had disappeared in 17 (63%) of 27 cases negative for HPV DNA and was persistent or progressive in 12 (75%) of 16 cases positive for HPV DNA., Conclusion: The clinical course of LCIN correlates well with HPV infection.

Objective: The purpose of this study was to determine the incidence of positive peritoneal cytology and to elucidate the prognostic value of peritoneal cytology in patients with uterine cervix and endometrial cancer., Materials and Methods: The incidence of positive peritoneal cytology was investigated in 642 patients including 339 uterine cervix and 303 endometrial cancers. Survival was estimated by the Kaplan-Meier method in a subgroup of 116 stage II cervix and 199 stage I endometrial cancers, and multivariate analysis using Cox's proportional hazards model was used to identify an independent prognostic factor., Results: The incidence of positive peritoneal cytology was found to be 9% in uterine cervix cancer and 15% in endometrial cancer. The incidence was higher in patients with some clinicopathologic status such as advanced stage, lymph node metastasis, ovarian metastasis, and deeper myometrial invasion. The 5-year survival rate for patients with positive or negative peritoneal cytology was 44 or 80% in stage II cervix cancers and 80 or 92% in clinical stage I endometrial cancers, respectively. Multivariate analysis revealed that independent prognostic determinants were pelvic and paraaortic lymph node metastasis and peritoneal cytology in stage II cervix cancer and peritoneal cytology in stage I endometrial cancer. Proper treatment protocol should be scheduled for patients with positive peritoneal cytology.

Objective: To investigate the cytologic and pathologic features of endocervical lesions in cases of gastric adenocarcinoma metastatic to the uterine cervix., Study Design: From 1986 to 1994, four patients with gastric adenocarcinoma metastatic to the uterine cervix were treated at our department. The cervical cytologic samples were obtained by swabbing and were stained by the Papanicolaou method. Presence of tumor diathesis, number of atypical cells, cell arrangement, cytoplastic vacuoles, cellular and nuclear diameter, chromatin distribution and size of the nucleolus were investigated., Results: The smear backgrounds were dirty (tumor diathesis) in two cases and clean in two. No significant difference in the number of atypical cells or in cell or nuclear diameter between primary and metastatic adenocarcinoma was shown. Cell arrangement was the different cytologic finding between primary and metastatic adenocarcinoma. Sheetlike or isolated arrangement was seen frequently in metastatic cervical adenocarcinoma., Conclusion: Because different cytologic features have been found in past and the present series, cytologic diagnosis of metastatic cervical adenocarcinoma should be made carefully.

Objective: To investigate the accuracy rates of cytology, colposcopy and punch biopsy in early cervical neoplasia confirmed by conization., Study Design: During the 10 years from 1984 to 1993, cold knife conization was performed on 151 patients with early cervical neoplasia proven by punch biopsy at our department. The accuracy rates of cytology, colposcopy and punch biopsy were investigated., Results: The accuracy rates of cytology, colposcopy and punch biopsy were 52% (78 of 151), 66% (100 of 151) and 66% (100 of 151), respectively., Conclusion: These results suggest that a composite diagnosis with cytology, colposcopy and punch biopsy is necessary for a correct evaluation. Early cervical neoplasms are frequently seen in young women, and conservative procedures, such as conization, cryosurgery and laser vaporization, are the treatments of choice in order to preserve reproductive function. We recommend conization as the best conservative procedure, with preservation of reproductive function.

The usefulness of MR imaging (MRI) in uterine cervical cancer after radiotherapy was evaluated in 18 patients. MRI was performed before and within one month after radiotherapy. In eight patients the uterus assumed a nearly normal appearance with resolution of the tumor on MRI. In another eight patients the tumors resolved, but an area of high signal intensity remained at the cervix. In these patients the tumors were well controlled at clinical examinations and during the mean follow-up period of 15-18 months. Therefore a persistent area of high signal intensity alone at the cervix on MRI is not itself indicative of residual tumor. An area of high signal intensity and a residual cervical mass persisted in two cases, and they were histologically proven to be due to residual tumor. Both patients died of recurrent disease at seven and 11 months after their radiotherapy. We conclude that MRI is useful for evaluating patients with cervical cancer at the completion of radiotherapy, and that MRI complements conventional clinical examinations.

To elucidate the accuracy of cytology in diagnosing cervical intraepithelial neoplasia (CIN) during pregnancy, cytologic screenings for uterine cervical cancer in pregnant women were reviewed for a five-year period. Of the 967 pregnant women screened, abnormal cytologic findings were recorded for 15 (1.6%). Only nine of these were subsequently examined by colposcopy and punch biopsy, which demonstrated CIN in all cases, for an incidence of documented CIN during pregnancy of 0.93%. Including two referral cases also examined by colposcopy and biopsy, cytology and histology agreed on the degree of CIN in four cases and disagreed by one degree in four cases, by two degrees in two cases and by three degrees (mild dysplasia versus carcinoma in situ) in one case. Review of the specimens from these cases did not readily explain the poor concordance between cytology and punch biopsy; some findings suggest that overestimation of the punch biopsy sample may be the explanation.

An extremely rare case of in situ adenocarcinoma of the uterine cervix that developed into invasive cancer is reported. The patient was a 54-year-old Japanese female who complained of vaginal spotting. Pelvic examination revealed no abnormalities and routine Papanicolaou smear was misinterpreted as negative. Multiple wedge biopsies of the uterine cervix were done because Papanicolaou smears taken after 7 months were reported as suspicious. The wedge biopsy revealed dysplastic changes of the endocervical glands. It was diagnosed as being in situ adenocarcinoma by a later review. The patient was examined by cytology and colposcopy every 3 to 12 months. An advanced adenocarcinoma was found in the uterine cervix after 5 years. Total abdominal hysterectomy, resection of the vagina and cardinal ligament, and postoperative irradiation were performed. The patient is alive and well at this writing. This is the second case of in situ adenocarcinoma of the uterine cervix that developed into invasive cancer.

From January, 1973 to December, 1980, 396 cases of cervical cancer were treated with radical hysterectomy under the diagnoses of stage Ib, IIa and IIb. Precise postoperative pathological examinations about the extirpated uterus revealed that 63 of them had only early invasive cancer or less advanced lesions though they had been considered as frank invasive cancer by preoperatively performed biopsies. The major causes of the misinterpretations were, 1) misjudging the glandular involvements as frank invasive lesions, or 2) misjudging the tangentially sectioned lesions of the bulky outgrowth as frank invasions. Furthermore, it is sometimes difficult to identify the invasive lesions in the biopsy specimens whether they are early invasive or frank invasive. Colposcopic and cytological examinations were simultaneously performed to each cases. Either cytology or colposcopy did not suggest frank invasions in 44.2% of cases. Both of them did not suggest frank invasions in 37.2% of cases. At least, cone biopsy should have been performed to identify the degree of invasions of these 37.2% cases. The authors emphasize that the directed biopsies are not always accurate to diagnose the early invasions, and one should use colposcopy, cytology and directed biopsy to make an accurate diagnosis.

One hundred and three patients with dysplasia, carcinoma in situ, or microinvasive carcinoma of the uterine cervix were treated with cryosurgery during 8 years from 1972 to 1978. Twenty-nine patients underwent several types of operations during 4-41 days (mean 18 days) after cryosurgery, and 74 patients were followed for 3-78 months (mean 3 years) after treatment. Seventy-six per cent of the patients who underwent an operation had residual lesions in their histologic materials. Seventy per cent of the patients who were followed, on the other hand, showed consecutively negative cytology and pathology after cryosurgery. It is necessary for the more effective management of CIN with cryosurgery to perform endocervical curettage in every case, to select small lesion for treatment, and to use more powerful method of cryocauterization.

The cytologic features of six cases of stomach cancer metastatic to the uterine cervix are presented. Atypical cells were found in cytology samples from four patients. Fewer atypical cells, larger cellular and nuclear areas, more discrete vacuoles, increased frequencies of thickening of the nuclear membrane and more coarsely granular chromatin patterns were the characteristic cytologic findings of metastatic cervical adenocarcinoma as compared with primary endocervical adenocarcinoma.

To establish the differential diagnosis of repair cells from malignant cells, 624 repair cells from 11 cases, 547 cells derived from 8 adenocarcinomas and 593 cells from 8 squamous-cell carcinomas were analyzed, with stress on the morphology of the nucleoli. Such planimetric data as mean cellular areas, mean nuclear areas, mean nucleolar areas, nuclear-cytoplasmic ratios and nucleolar-nuclear ratios were fairly similar among the three cell groups. However, the even distribution of nucleoli in the nuclei, the decrease in C-type nucleoli and nucleoli consistently linked with nucleolus-associated chromatin were noted to be reliable criteria for the diagnosis of repair cells along with such well-known morphologic characteristics as the sheetlike arrangement of repair cells, the lack of isolated forms, the finely granular chromatin pattern and the round, smooth nuclear configuration with a thin nuclear membrane.

Therapeutic efficacy of cervical conization was examined on 93 patients with borderline lesions of the uterine cervix who underwent hysterectomy following conization. No lesions or only minimal residual lesions were found at subsequent hysterectomy when the surgical margins of cone specimens were not involved in the malignant or premalignant lesions. From these results, we concluded that cervical conization could be considered as a therapeutic procedure when the following conditions were fulfilled. Cone specimens are sufficient in size. Both endocervical and exocervical margins are negative. No malignancy is found on endocervical curettage. No abnormal cytologic findings are found after conization. Another follow-up study was performed on 69 patients who received therapeutic conization between 1971 and 1981. Among them one developed stage II cervical cancer two years after the last follow up. Two other patients had recurrent CIN in the cervix and another patient was found to have an endometrial cancer. These patients were successfully treated after early detection of the lesions by the cytological examination. From these facts, cytological examination is recommended in the follow-up after therapeutic conization.

Two hundred fifty-five cases of International Federation of Gynecology and Obstetrics (FIGO) Stage Ib, IIa, and IIb cases of cervical cancer were analyzed following radical surgery with regard to the extent of invasion into vagina, parametria, and pelvic lymph nodes. Restaging was carried out based on the findings. Discrepancies were found between FIGO stages and the actual extent of the disease, particularly in Stage IIb. Among 99 cases of Stage IIb, only 42.4% were correctly staged. The 5-year disease-free survival by FIGO and postsurgical stagings were, respectively: Ib, 88.4% and 87.0%; IIa, 85.2% and 95.0%; IIb, 70.7% and 62.3%. Prognostic significance in the pathologic examination of operated materials was demonstrated when there were deep stromal invasions of cancer cell or parametrial invasions or pelvic lymph node metastases. When cancer was present in both of the parametrium and pelvic lymph nodes, the prognosis of the patient worsened (5-year survival rate, 41.4%).

Mass screening for cancer of the uterine cervix was performed mainly in a screening car or by a gynecological practitioner in Fukuoka Prefecture. In 1983, 114,000 women were screened for cervix cancer, and 102 cervix cancers were detected. Cytology activity index was 110. To reduce deaths from cervix cancer, 400,000 women should be screened by cytology. Detection of cancer in the population with abnormal cytology was not satisfactory in some departments. The gynecologists in these departments should be trained for colposcopic practice. The training of cytotechnologists is also necessary for the elimination of false negative cytology. These trainings are now being done under the law of health for the elderly.