The importance of monitoring protocols in cervical carcinoma screening

Romania has supremacy in terms of European statistical indicators of cervical cancer, a fact attested by the studies made by international organizations. The present study is based on cytological evaluation of a group of 9269 cervico-vaginal smears, segregated in various groups that were monitored by standard diagnostic and therapeutic protocols, attitude based on an excellent collaboration with the gynecologist. This cooperation led to the elaboration of a set of protocols for follow-up of patients assessed by Babes-Papanicolaou test, in order to assure an adequate management for all cervical lesions. An important feature of this study is that histopathological examination of cases cytologically designated as HSIL showed, along with changes of HSIL-CIN2 and HSIL-CIN3, also carcinoma in situ and invasive squamous cell carcinoma lesions, emphasizing the importance of the pathologic diagnosis of certainty. This idea is also supported in cases of glandular cell atypia, whose microscopic evaluation identified premalignant and malignant lesions, both in endometrial and endocervical site. A particular aspect of the analyzed batch consists in the description of a subgroup of false-negative cytodiagnostic results associated with cervical carcinoma, highlighting the causes and the possibilities to avoid further errors. Overall analysis of results reveals major involvement of the pathologist in providing the sequence from cytology to histopathological diagnosis and to establish diagnostic continuity.