[Difficulties in cytological diagnosis of changes in the endocervix]

1. Cytological diagnosis of changes of the cylindrical epithelium in the endocervix has not been elaborated in such detail as the cytodiagnosis of squamous epithelium of the ectocervix. 2. The original proposal and experience of Vooijs of 1995 for the classification of incipient endocervical lesions corresponds best to histological practice. 3. Cytodiagnosis of endocervical changes will be more accurate if we use for evaluation the cellular pattern from the endocervix, demonstrated on the plates. 4. If we find any cellular abnormalities of the cylindrical epithelium, we recommend a procedure as used in lesions of squamous epithelium a) Low-grade abnormalities should be followed up primarily by cytological methods. If the lesion persists or progresses, histological examination is indicated. Examination of an endocervical lesion is usually not accessible to colposcopy. b) High-grade abnormalities and in particular those with the above described architecture, should be subjected to histological examination. 5. In mixed cylindrical and squamous lesions the procedure depends on the more serious lesion. In mixed lesions or suspected mixed lesions it is an advantage to use histochemical examination for betagalactosidase, the method described by Lojda, which differentiates safely the squamous and cylindrical component and in particular its tendency of malignant reversal.