GYNECOLOGIC
ONCOLOGY
45, 9-12
(1992)
A Population-Based Study of Microinvasive Disease of the CervixA Colposcopic and Cytologic Analysis EVANGELOS *Department
PARASKEVAIDIS,*
of Gynaecology,
TDepartment
HENRY C. KITCHENER,* IAN D. MILLER,? PETER M. FISHER* of Pathology,
and #Department Scotland, United Received
April
A study of 61 casesof microinvasionof the cervix occurring in our population between1980and 1989is reported. The mean age of the women was 39 years, compared with 30 years for cervical intraepithelial grade 3 (CIN III) and 47 years for frank invasion, respectively. Colposcopicsuspicionof microinvasion was present in 31 cases,giving a sensitivity of colposcopicdiagnosisof 50%and a specificity of 91%. In 21 cases(34%) there was no suspicioneither cytologically or colposcopicallyof microinvasion.Colposcopypredictedmicroinvasionmoreaccurately with increasingdepth of invasion. In 28 womenthere had been previous smearswithin 10 years available for review. The time interval betweenthe first abnormal smearand the histological diagnosisranged from 1 month to 9.8 years (mean, 4 years). 0 1992 Academic
Press, Inc.
INTRODUCTION In well-organized screening programs designed to prevent invasive disease, microinvasion will be detected histologically by cone biopsy performed either because colposcopy was unsatisfactory or because there was colposcopic or cytologic suspicion of microinvasion. Several retrospective studies have attempted to identify cytologic features [l-3] that predict microinvasion and to correlate the colposcopic features [4] in proven microinvasion. However, these studies have not addressed the sensitivity and specificity of these observations, which should be considered when their clinical usefulness is addressed. Cytological markers are of limited value, as abnormal cytology demands expert colposcopic examination, which will largely dictate clinical management. Another area of interest is the natural history of microinvasive disease. There has been an increase in the incidence of high-grade CIN during the 1980s particularly among young women. A prospective study of the natural history of high-grade CIN in terms of the development
of Cytopathology, Kingdom
EVELYN
MANN,$
Aberdeen
Royal
LATA JANDIAL,+ Infirmary,
Aberdeen
AND AB9 2ZA,
30, 1991
of microinvasive disease is clearly both unethical and impractical; therefore data must be sought in a retrospective fashion in proven cases. The Aberdeen cytology laboratory serves Grampian Region, which has a well-defined stable population. There has been a well-organized screening program that has resulted in a decline of cervical cancer [5]. The policy has been to place women with a mild or moderately dyskaryotic smear under cytological surveillance, referring those thought to have CIN III for colposcopy. This background permits unbiased population-based data. The principal aims of this study were to calculate the incidence of microinvasion relative to high-grade CIN and invasive disease, to evaluate the sensitivity and specificity of colposcopy in predicting microinvasion, and to analyze smear histories, where available, of women who had developed microinvasion. PATIENTS
AND METHODS
Since 1980 all patients in the Grampian area of Scotland with abnormal cytology suggesting possible CIN III have been referred for colposcopic evaluation. The record cards of all these women have been reviewed. The histological criteria of microinvasive disease are defined by FIGO, i.e., depth of
ONCOLOGY
45, 9-12
(1992)
A Population-Based Study of Microinvasive Disease of the CervixA Colposcopic and Cytologic Analysis EVANGELOS *Department
PARASKEVAIDIS,*
of Gynaecology,
TDepartment
HENRY C. KITCHENER,* IAN D. MILLER,? PETER M. FISHER* of Pathology,
and #Department Scotland, United Received
April
A study of 61 casesof microinvasionof the cervix occurring in our population between1980and 1989is reported. The mean age of the women was 39 years, compared with 30 years for cervical intraepithelial grade 3 (CIN III) and 47 years for frank invasion, respectively. Colposcopicsuspicionof microinvasion was present in 31 cases,giving a sensitivity of colposcopicdiagnosisof 50%and a specificity of 91%. In 21 cases(34%) there was no suspicioneither cytologically or colposcopicallyof microinvasion.Colposcopypredictedmicroinvasionmoreaccurately with increasingdepth of invasion. In 28 womenthere had been previous smearswithin 10 years available for review. The time interval betweenthe first abnormal smearand the histological diagnosisranged from 1 month to 9.8 years (mean, 4 years). 0 1992 Academic
Press, Inc.
INTRODUCTION In well-organized screening programs designed to prevent invasive disease, microinvasion will be detected histologically by cone biopsy performed either because colposcopy was unsatisfactory or because there was colposcopic or cytologic suspicion of microinvasion. Several retrospective studies have attempted to identify cytologic features [l-3] that predict microinvasion and to correlate the colposcopic features [4] in proven microinvasion. However, these studies have not addressed the sensitivity and specificity of these observations, which should be considered when their clinical usefulness is addressed. Cytological markers are of limited value, as abnormal cytology demands expert colposcopic examination, which will largely dictate clinical management. Another area of interest is the natural history of microinvasive disease. There has been an increase in the incidence of high-grade CIN during the 1980s particularly among young women. A prospective study of the natural history of high-grade CIN in terms of the development
of Cytopathology, Kingdom
EVELYN
MANN,$
Aberdeen
Royal
LATA JANDIAL,+ Infirmary,
Aberdeen
AND AB9 2ZA,
30, 1991
of microinvasive disease is clearly both unethical and impractical; therefore data must be sought in a retrospective fashion in proven cases. The Aberdeen cytology laboratory serves Grampian Region, which has a well-defined stable population. There has been a well-organized screening program that has resulted in a decline of cervical cancer [5]. The policy has been to place women with a mild or moderately dyskaryotic smear under cytological surveillance, referring those thought to have CIN III for colposcopy. This background permits unbiased population-based data. The principal aims of this study were to calculate the incidence of microinvasion relative to high-grade CIN and invasive disease, to evaluate the sensitivity and specificity of colposcopy in predicting microinvasion, and to analyze smear histories, where available, of women who had developed microinvasion. PATIENTS
AND METHODS
Since 1980 all patients in the Grampian area of Scotland with abnormal cytology suggesting possible CIN III have been referred for colposcopic evaluation. The record cards of all these women have been reviewed. The histological criteria of microinvasive disease are defined by FIGO, i.e., depth of
