False-negative cytology in invasive cancer of the cervix.

The mainstay of early diagnosis of CIN is exfoliative cytologic screening of the cervicovaginal area. The Achilles heel in this tremendously valuable screening process is the high false negativity rate. The false negativity rate can be diminished by rigid adherence to indications for screening, screening technique, proper interpretation and reporting, and utilization, where indicated, of adjunctive diagnostic methods such as multiple biopsy, colposcopy, and maintenance of the annual screening schedule in the majority of patients.

Squamous neoplasia of vagina related to DES syndrome.

The emphasis to date in the DES syndrome has been confined to the presence of adenosis in the vagina and the occassional adenocarcinoma which may arise from this ectopic glandular epithelium (less than 250 to date). As these patients mature, however, the glandular epithelium in the vagina is replaced by squamous metaplastic epithelium. Forty-six patients with benign vaginal adenois were observed colposcopically for up to 2 years. Atypical squamous epithelium (white epithelium, punctation, or mosiac pattern) was observed in 40 of the 46 patients. Colposcopically directed biopsy revealed six cases ofdysplasia (mild to severe) and one unequivocal case of in situ squamous carcinoma. These squamous lesions in the vagina were identical, both colposcopically and histologically,to similiar lesions on the cervix. These data suggest that squamous neoplasia may be more frequent in the future of the DES-exposed patient than adenocarcinoma.

Clinical diagnosis of vaginal adenosis.

PIP: The increased incidence of vaginal adenosis in young girls whose mot hers were given diethylstilbestrol (DES) during pregnancy has heightened the interest and clinical awareness of this teratogenic process. In these cases, exfoliative cytology is usually negative and Schiller's iodine test is imprecise. Examinations were made of 63 young women (12-23 years old) whose mothers had been given DES during the first trimester of pregnancy. 55 were asymptomatic, 6 had noticed a mucus vaginal discharge, 2 had complained of dyspareunia, and none had been pregnant. Cytology of 3 was atypical. In 24, the usual gynecological examination was reported as normal. In 7, a lesion suggesting adenosis had been observed. Visual examination of the cervix and vagina revealed 3 with atypical gross findings. A circular fold in the vaginal fornices partially covered the cervix in 9 cases. Cervical irregularity was observed in another 9 cases. Erythroplakia (reddish brown areas on the cervix or vagina) seen in 8 patients represented columnar epithelium inflammation, or neoplasia. Gross inspection did not determine the pathology. In 41 (71 percent) gross examination of the cervix and vagina failed to reveal any changes. By colposcopic examination columnar epithelium on the surface of the vagina was found in 24 cases (38 percent). After the acetic acid test, grapelike structures of columnar epithelium were visible. In 57 patients (91 percent), columnar epithelium was found in the vaginal wall; these were classified as vaginal adenosis. In 6 patients, the columnar epithelium was seen only on the periphery of the cervix. The incidence of vaginal adenosis seems to correlate directly with methods of detection as most cases are asymptomatic. The diagnosis is difficult to establish by conventional clinical methods. Colposcopic examination was an accurate method, particularly in cases which were not apparent by other methods. Biopsies may be needed also.^ieng