4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta

4. Hrvatski kongres kliniËke citologije / 1. Hrvatski simpozij analitiËke citologije / 2. Hrvatski simpozij citotehnologije
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Klinička citologija - Usmena predavanja
IS THE HSIL SUBCLASSIFICATION CYTOLOGICALLY REAL AND CLINICALLY JUSTIFIED?
Miličić-Juhas V, Pajtler M
Department of Clinical Cytology, Clinical Hospital Osijek, Osijek, Croatia
The purpose of this work was to evaluate the justification of Croatian modification of
Bethesda classification after thirteen years of its application, answering the question
is the subclassification of HSIL into CIN2 and CIN3 cytologically real and clinically justified.
The retrospective study covered 3110 women examinees at Clinical Department
in Clinical hospital Osijek from 1993 to 2005. By cytological examination of VCE smear
intraepithelial lesion of cervix of different weight has been diagnosed. Cytologically and
colposcopically 57,1% women examinees were monitored, while 42,9% had also pathohistological
examination. In determining the lesion’s biological behaviour, regression
has been defined with two or more negative control cytological findings in a year or
more, persistence was defined with two or more abnormal or intermittently abnormal
control cytological findings, which pointed out the intraepithelial squamous lesion of
different weight in a year or more, while progression was defined with cytological finding
which pointed out the invasive lesion. Positive predictive value has been estimated
on the base of comparison of the worst cytological finding with the worst pathological
finding not depending on histological sample. The spontaneous regression of cytological
finding showed in 66,3% cases. CIN2 regressed significantly more often (in 50,98%
cases) than CIN3 (31,3%) and considerably more rarely than CIN1 (70,1%). Comparing
the first and the worst cytological diagnosis during monitoring, it has been found that
CIN1 is also the heaviest diagosis in 80,1% cases, while in 19,9% of examinees the initial
diagnoses progressed in heavier lesion. CIN2 was also the heaviest cytological diagnosis
in 65,35 cases, and it progressed in CIN3 in 34,1% cases. CIN2 progressed more often
in CIN3 than CIN1 (34,1% in relation to 12,7%). The positive predictive value of cytological
differential diagnoses CIN3 (84,3%) is significantly higher than CIN2 (36,9%), and CIN1
(44,3%), but positive predictive value of CIN1 and CIN2 doesn’t considerably differ. Pathohistologically
CIN3 has been found considerably more often in cytological diagnosis CIN2
(38,9%) than in cytological diagnosis CIN1 (22,8%), but significantly more rarely than in
cytological diagnosis CIN3 (84,2%). Therefore, cytological CIN2 and CIN3 lesions differ
mutually in biological behaviour, and histological finding. Namely, 50,9% of CIN2 spontaneously
regressed, additional 14,4% persisted during monitoring, i.e. didn’t progress
in CIN3 or heaviest lesion, and 59,7% had a histological finding less than CIN3. In other
words, in almost 65% of CIN2 lesions it is not justified to apply diagnostic therapeutic
procedures for CIN3 lesions. In accordance with this, the cytological subclassification
of HSIL on CIN2 and CIN3 lesions is clinically justified. The positive predictive value of
cytological differential diagnosis CIN2 is significantly lower than CIN3, but doesn’t differ
significantly from CIN1, so CIN2 is equally real cytological differential diagnosis as CIN1,
which is classified as an independent diagnosis in all classifications, so based on this the
subclassification of HSIL is cytologically possible.
valerija.mj@gmail.com