Cytomorphologic and cytochemical analysis in the differential diagnosis of cervical epithelial lesions

There is an increasing tendency to eradicate all cytologically diagnosed cervical epithelial lesions. A considerable number of the milder atypias are, however, known to originate from benign reactive cell populations. In nine women with initial mild or moderate dysplasia who had been followed by cytologic controls for 5 to 15 years, DNA analysis was retrospectively performed in characteristic smears from the follow-up. Progression to carcinoma in situ in six patients was invariably accompanied by a sequence of increasing DNA pattern deviations. In three patients with cervicitis as the final diagnosis, DNA patterns were constantly within normal limits. Although DNA analysis cannot conclusively determine whether a cell population is truly neoplastic, the method can establish the DNA pattern in a cell population as within normal limits or as clearly deviating from normal. A combination of cytomorphologic and cytophotometric diagnostic methods is suggested as a means to improve the differential diagnosis in cervical lesions between cell populations representing true dysplasias, i.e., premalignant lesions, and those resulting from reactive lesions and thus to avoid unnecessary overtreatment of nonneoplastic cervical abnormalities.