[Histological diagnosis of precancerous and early stages in cancer of the cervix uteri].

Abstract

The histologic diagnosis of premalignant and early malignant lesions of the cervix uteri necessitates the teamwork of histologists and clinicians. This cooperation amounts to: 1. the indication for biopsy; 2. the technic of biopsy; 3. the histologic technic; 4. the agreement of nomenclature of pathologic epithelium with identical prognostic evaluation of the different lesions. The indication for biopsy is confirmed by the result of cytology and colposcopy. In every single case seeming suspicious either by cytology or colposcopy a biopsy must be done. Great numbers of biopsies require a method which can be performed at an outpatient department, such as Schiller's scraping, punch biopsy and curettage of the cervical channel. The positive diagnosis originating from such a small biopsy specimen only justifies the necessity of treatment, not however the method of therapy. The extent of treatment is determined by the histologic diagnosis of cone biopsy which has to be done next. At what extent, depends on the visibility of the whole lesion and especially on the visibility of the maximum of possible existent invasion. Good technic of conization and step serial sections satisfy this condition. If handled as said reduced cancer therapy is admissible: in cases of carcinoma in situ or of severe dysplasia by conization or by total hysterectomy; in cases of early stromal invasion by hysterectomy or even by conization. Whether or not a reduced cancer therapy was permissible, also in cases of microcarcinoma, is to be decided by follow up controls of cases treated by these methods. Here too the condition is the exact determination of the whole lesion by step serial sections of the cone.