Abstract
The cervix is composed of fibromuscular and elastic tissue, and is lined by columnar and squamous epithelium. The vaginal portion of the cervix is generally lined by a nonkeratinizing squamous stratified epithelium, whereas the mucosa of the endocervical canal is composed of a single layer of mucin-secreting columnar epithelium.
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References
Ferenczy A, Winkler B. Cervical intraepithelial neoplasia and condyloma. In: Kurman RJ, ed. Blaustein’s Pathology of the Female Genital Tract, 3rd ed. New York: Springer-Verlag; 1987: 177–217.
DiSaia PJ, Creasman WT. Preinvasive disease of the cervix, vagina, and vulva. In: Clinical Gynecologic Oncology, 3rd ed. St. Louis, Mo: CV Mosby Company; 1989: 1–48.
Koss LG. Dysplasia. A real concept or a misnomer? Obstet Gynecol. 1978; 51: 374–379.
Abdul-Karim FW, Fu YS, Reagan JW, et al. Morphometric study of intraepithelial neoplasia of the uterine cervix. Obstet Gynecol. 1982; 60: 210–214.
Saito K, Saito A, Fu YS, et al. Topographic study of cervical condyloma and intraepithelial neoplasia. Cancer. 1987; 59: 2064–2070.
Richart RM. Colpomicroscopic studies of cervical intraepithelial neoplasia. Cancer. 1966; 19: 395–400.
Richart RM. Colpomicroscopic studies of the distribution of dysplasia and carcinoma in situ on the exposed portion of the human uterine cervix. Cancer. 1965; 18: 950–954.
Wright TC, Richart RM. Pathogenesis and diagnosis of preinvasive lesions of the lower genital tract. In: Hoskins WJ, Perez CA, Young RC, eds. Principles and Practice of Gynecologic Oncology. Philadelphia, Pa: JB Lippincott Company; 1992: 509–536.
Richart RM. Natural history of cervical intraepithelial neoplasia. Clin Obstet Gynecol. 1968; 10: 748–784.
Richart RM. A modified terminology for cervical intraepithelial neoplasia. Obstet Gynecol. 1990; 75: 131–133.
Koss LG, Stewart FW, Foote FW, et al. Some histological aspects of behavior of epidermoid carcinoma in situ and related lesions of the uterine cervix. Cancer. 1963; 16: 1160–1211.
Mclndoe WA, McLean MR, Jones RW, et al. The invasive potential of carcinoma in situ of the cervix. Obstet Gynecol. 1984; 64: 451–458.
Fox CH. Biologic behavior of dysplasia and carcinoma in situ. Am J Obstet Gynecol. 1967; 99: 960–974.
Hall JE, Walton L. Dysplasia of the cervix: a prospective study of 206 cases. Am J Obstet Gynecol. 1968; 100: 662–671.
Nasiell K, Roger V, Nasiell M, et al. Behavior of mild cervical dysplasia during longterm follow-up. Obstet Gynecol. 1986; 67: 665669.
Nasiell K, Nasiell M, Vaclavinkova V, et al. Behavior of moderate cervical dysplasia during long-term follow-up. Obstet Gynecol. 1983; 61: 609–614.
Barron BA, Richart RM. A statistical model of the natural history of cervical carcinoma based on a prospective study of 557 cases. JNCI. 1968; 41: 1343–1353.
Barron BA, Richart RM. A statistical model of the natural history of cervical carcinoma. II. Estimates of transition time from dysplasia to carcinoma in situ. JNCI. 1970; 45: 1025 1030.
Richart RM, Barron BA. A follow-up study of patients with cervical dysplasia. Am J Obstet Gynecol. 1969; 105: 386–393.
Reid R, Fu YS, Hershman RR, et al. Genital warts and cervical cancer. VI. The relationship between aneuploid and polyploid lesions. Am J Obstet Gynecol. 1984; 150: 189–199.
Fu YS, Reagan JW, Richart RM. Precursors of cervical cancer. Cancer Sury 1983; 2: 359.
Fu YS, Huang I, Beaudenon S, et al. Correlative study of HPV, DNA histopathology and morphometry in cervical condyloma and intraepithelial neoplasia. Int J Gynecol Pathol. 1988; 7: 297.
Bergeron C, Ferenczy A, Shah KV, et al. Multicentric human papilloma virus infections of the female genital tract: correlation of viral types with abnormal mitotic figures, colposcopic presentation, and location. Obstet Gynecol. 1987; 69: 736–742.
Winkler B, Crum PC, Fujii T, et al. Koilocytotic lesions of the cervix: the relationship of mitotic abnormalities to the presence of papillomavirus antigens and nuclear DNA content. Cancer. 1984; 53: 1081–1087.
Lorincz AT, Reid R, Jenson B. Human papillomavirus infection of the cervix: relative risk associations of common anogenital types. Ob-stet Gynecol. 1992; 79: 328–337.
Reid R, Stanhope R, Herschman BR. Genital warts and cervical cancer. I. Evidence of an association between subclinical papillomavirus infection and cervical malignancy. Cancer. 1982; 50: 377–387.
Reid R, Greenberg M, Jenson B. Sexually transmitted papillomaviral infections. I. The anatomic distribution and pathologic grade of neoplastic lesions associated with different viral types. Am J Obstet Gynecol. 1987; 156: 21 2222.
Kiviat NB, Koutsky LA, Paavonen JA. Prevalence of genital papillomavirus infection among women attending a college student health clinic or a sexually transmitted disease clinic. J Infect Dis. 1989; 159: 293–302.
Lorincz AT, Temple GF, Patterson JA. Correlation of cellular atypia and human papillomavirus deoxyribonucleic acid sequences in exfoliated cells of the uterine cervix. Obstet Gynecol. 1986; 68: 508–512.
van de Brule A, Claas E, Maine M et al. Application of anticontamination primers in the polymerase chain reaction for the detection of human papillomavirus genotypes in cervical scrapes and biopsies. J Med Virol. 1989; 29: 20–27.
Koss LG. The Papanicolaou test for cervical cancer detection. JAMA. 1989; 261: 737–743.
Papanicolaou GN. A survey of the actualities and potentialities of exfoliative cytology in cancer diagnosis. Ann Med. 1948; 30: 661.
Papanicolaou GN, Traut HF. Diagnostic value of vaginal smears in cancer of the uterus. Am J Obstet Gynecol. 1941; 42: 193–206.
Miller AB, Lindsey J, Hill GB. Mortality from cancer of the uterus in Canada and its relationship to screening for cancer of the cervix. Int J Cancer. 1976; 17: 602–612.
Christopherson WM, Mendez WM, Ahuja EM, et al. Cervix cancer control in Louisville, Kentucky. Cancer. 1970; 26: 29–38.
Canadian Task Force. Cervical cancer screening programs. I. Epidemiology and natural history of carcinoma of the cervix. Can Med Assoc J. 1976; 114: 1003–1033.
Day NE. Effect of cervical cancer screening in Scandinavia. Obstet Gynecol. 1984; 63: 714–718.
Christopherson WM. Trends in mortality from uterine cancer in relation to mass screening. Acta Cytol. 1977; 21: 5–9.
Papanicolaou G. Atlas of Exfoliative Cytology. Boston, Mass: Commonwealth Fund by University Press; 1954.
Riotton G, Christopherson WM. Cytology of the female genital tract. In: International Histological Classification of Tumors #8. Geneva: WHO; 1973.
National Cancer Institute Workshop. The 1988 Bethesda system for reporting cervical/ vaginal cytologic diagnoses. JAMA. 1989; 262: 931–934.
National Cancer Institute Workshop. The revised Bethesda system for reporting cervical/ vaginal cytologic diagnoses: Report of the 1991 Bethesda workshop. J Repro Med. 1992; 37: 383–386.
Nelson JH, Averette HE, Richart RM. Cervical intraepithelial neoplasia (dysplasia and carcinoma in situ) and early invasive cervical carcinoma. CA. 1989; 39: 157–178.
La Vechia C, Francesschi S, Decarli A, et al. “Pap” smear and the risk of cervical neoplasia: Quantitative estimates from a case-control study. Lancet. 1984; 2: 779–782.
MacGregor E, Moss SM, Parkin DM, et al. A case-control study of cervical cancer screening in northeast Scotland. Br Med J. 1985; 290: 1543–1546.
Wangsuphachart V, Thomas DB, Koetsawang A, et al. Risk factors for invasive cervical cancer and reduction of risk by “Pap” smears in Thai women. Int J Epidemiol. 1987; 16: 363–366.
Olesen F. A case-control study of cervical cytology before diagnosis of cervical cancer in Denmark. Int J Epidemiol. 1988; 17: 501–508.
Shy K, Chu J, Mandelson M, et al. Papanicolaou smear screening interval and risk of cervical cancer. Obstet Gynecol. 1989; 74: 838–843.
Cervical cancer screening: Summary of an NIH consensus statement. Br Med J. 1980; 281: 1264–1266.
Canadian Task Force. Cervical cancer screening programs: summary of the 1982 Canadian task force report. Can Med Assoc J. 1982; 127: 581–589.
Fink DJ. Change in American Cancer Society checkup guidelines for detection of cervical cancer. CA. 1988; 38: 127–128.
Pearse WH. Consensus report on frequency of Pap smear testing. American College of Obstetricians and Gynecologists, Newsletter. 1988; 32: 3.
Richart RM, Valiant HW. Influence of cell collection techniques upon cytologic diagnosis. Cancer. 1965; 18: 1474–1478.
Ayre JE. Cervical cytology in diagnosis of early cancer. JAMA. 1948; 136: 513–517.
Rubio CA, Kock Y, Stormby N, et al. Studies on the distribution of abnormal cells in cytological smears. VII. Cervical brush versus plastic and wooden spatulas. Gynecol Oncol. 1990; 39: 167–170.
Elias A, Linthorst G, Bekker B, et al. The significance of endocervical cells in the diagnosis of cervical epithelial changes. Acta Cytol. 1983; 27: 225–229.
Vooijs PG, Elias A, van der Graaf Y, et al. Relationship between the diagnosis of epithelial abnormalities and the composition of cervical smears. Acta Cytol. 1985; 29: 323–328.
Boon ME, de Graaff Guilloud JC, Rietveld WJ. Analysis of five sampling methods for the preparation of cervical smears. Acta Cytol. 1989; 33: 843–848.
Kristensen GB, Holund B, Grinsted P. Efficacy of the cytobrush versus the cotton swab in the collection of endocervical cells. Acta Cytol. 1989; 33: 849–851.
Lai-Goldman M, Nieberg RK, Mulcahy D, et al. The cytobrush for evaluating routine cervicovaginal endocervical smears. J Repro Med. 1990; 35: 959–963.
Hoffman MS, Hill DA, Gordy LW, et al. Comparing the yield of the standard Papanicolaou and endocervical brush smears. J Repro Med. 1991; 36: 267–269.
Pretorius RG, Sadeghi M, Fotheringham N, et al. A randomized trial of three methods of obtaining Papanicolaou smears. Obstet Gynecol. 1991; 78: 831–836.
Koonings PP, Dickinson K, d’Ablaing G, et al. A randomized clinical trial comparing the cytobrush and cotton swab for Papanicolaou smears. Obstet Gynecol. 1992; 80: 241–245.
Murata PJ, Johnson RA, McNicoll KE. Controlled evaluation of implementing the cytobrush technique to improve Papanicolaou smear quality. Obstet Gynecol. 1990; 75: 690–695.
Selvaggi SM. Spatula/cytobrush vs. spatula/ cotton swab detection of cervical condylomatous lesions. J Repro Med. 1989; 34: 629.
van der Graaf Y, Vooijs GP, Gaillard HLJ, et al. Screening errors in cervical cytologic screening. Acta Cytol. 1987; 31: 434–438.
Boon ME, Alons-van Kordelaar JJM, Rietveld-Scheffers PEM. Consequences of the introduction of combined spatula and cytobrush sampling for cervical cytology: improvements in smear quality and detection rates. Acta Cytol. 1986; 30: 264–270.
Kawaguchi K, Nogi M, Ohya M, et al. The value of the cytobrush for obtaining cells from the uterine cervix. Diagn Cytopathol. 1987; 3: 262.
Beilby JOW, Bourne R, Guillebaud J, et al. Paired cervical smears: A method of reducing the false-negative rate in population screening. Obstet Gynecol. 1982; 60: 46–48.
Burke L, Antonioli DA, Ducatman BS. Tissue basis of colposcopy. In: Colposcopy Text and Atlas. East Norwalk, Conn: Appelton and Lange; 1991: 1–6.
Cartwright PS, Dao AH, Reed GW. Human papillomavirus in women: a three-year experience in a county hospital colposcopy clinic. J Repro Med. 1992; 37: 167–169.
Rader JS, Rosenzweig BA, Spirtas R, et al. Atypical squamous cells: a case-series study of the association between Papanicolaou smear results and human papillomavirus DNA genotype. J Repro Med. 1991; 36: 291–297.
Lindheim SR, Smith-Nguyen G. Aggressive evaluation for atypical squamous cells in Papanicolaou smears. J Repro Med. 1990; 35: 971–973.
Goff BA, Atanasoff P, Brown E, et al. Endocervical glandular atypia in Papanicolaou smears. Obstet Gynecol. 1992; 79: 101–104.
Urcuyo R, Rome RM, Nelson JH. Some observations on the value of endocervical curettage performed as an integral part of colposcopic examination of patients with abnormal cervical cytology. Am J Obstet Gynecol. 1977; 128: 787–792.
Coppleson M. Colposcopic features of papillomaviral infection and premalignancy in the female lower genital tract. Obstet Gynecol Clin North Am. 1987; 14: 471–494.
Staff A, Wilbanks GD. An international terminology of colposcopy: report of the nomenclature committee of the international federation of cervical pathology and colposcopy. Obstet Gynecol. 1991; 77: 313–314.
Reid R, Stanhope CR, Herschman BR, et al. Genital warts and cervical cancer. IV. A colposcopic index for differentiating subclinical papillomaviral infection from cervical intraepithelial neoplasia. Am J Obstet Gynecol. 1984; 149: 815–823.
Reid R, Scalzi P. Genital warts and cervical cancer. VII. An improved colposcopic index for differentiating benign papillomaviral infections from high-grade cervical intraepithelial neoplasia. Am J Obstet Gynecol. 1985; 153: 611–618.
Veridiano NP, Delke I, Tancer ML. Accuracy of colposcopically directed biopsy in patients with cervical neoplasia. Obstet Gynecol. 1981; 58: 185–187.
Staff A, Mattingly RF. Colposcopic diagnosis of cervical neoplasia. Obstet Gynecol. 1973; 41: 168–176.
Reid R: Preinvasive disease. In: Berek JS, Hacker NF, eds. Practical Gynecologic Oncology. Baltimore, Md: Williams and Wilkins; 1989: 195–239.
McCord ML, Stovall TG, Summitt RL, et al. Discrepancy of cervical cytology and colposcopic biopsy: Is cervical conization necessary? Obstet Gynecol. 1991; 77: 715–719.
Chanen W, Rome RM. Electrocoagulation diathermy for cervical dysplasia and carcinoma in situ: A 15-year survey. Obstet Gynecol. 1983; 61: 673–679.
Benedet JL, Nickerson KG, White GW. Laser therapy for cervical intraepithelial neoplasia. Obstet Gynecol. 1981; 58: 188–191.
Richart RM, Townsend D, Crisp W. An analysis of long term follow-up results in patients with cervical intraepithelial neoplasia treated by cryosurgery. Am J Obstet Gynecol. 1980; 137: 823–826.
Wright TC, Gagnon S, Richart RM, et al. Treatment of cervical intraepithelial neoplasia using the loop electrosurgical excision procedure. Obstet Gynecol. 1992; 79: 173–178.
Townsend DE, Richart RM. Cryotherapy and carbon dioxide laser management of cervical intraepithelial neoplasia: a controlled comparison. Obstet Gynecol. 1983; 61: 75–78.
Anderson MC, Hartley RB. Cervical crypt involvement by intraepithelial neoplasia. Obstet Gynecol. 1980; 55: 546–550.
Wright VC, Davies E, Riopelle MA. Laser surgery for cervical intraepithelial neoplasia: principles and results. Am J Obstet Gynecol. 1983; 145: 181–184.
Townsend DE, Richart RM. Diagnostic errors in colposcopy. Gynecol Oncol. 1981; 12: s259 - s264.
Pearson WE, Whittaker J, Ireland D, et al. Invasive carcinoma of the cervix after laser treatment. Br J Obstet Gynecol. 1989; 96: 486–488.
Townsend DE, Richart RM, Marks E, et al. Invasive cancer following outpatient evaluation and therapy for cervical disease. Obstet Gynecol. 1981; 57: 145.
Sevin B, Ford JH, Girtanner RD, et al. Invasive cancer of the cervix after cryosurgery. Obstet Gynecol. 1979; 53: 465–471.
Popkin DR. Treatment of cervical intraepithelial neoplasia with the carbon dioxide laser. Am J Obstet Gynecol. 1983; 145: 177180.
Benedet JL, Miller DM, Nickerson KG. Results of conservative management of cervical intraepithelial neoplasia. Obstet Gynecol. 1992; 79: 105–110.
Baggish MS, Dorsey JH, Adelson M. A ten-year experience treating cervical intraepithelial neoplasia with the CO2 laser. Am J Obstet Gynecol. 1989; 161: 60–68.
Deigan EA, Carmichael JA, Ohlke ID, et al. Treatment of cervical intraepithelial neoplasia with electrocautery: a report of 776 cases. Am J Obstet Gynecol. 1986; 154: 255–259.
Richart RM, Sciarra JJ. Treatment of cervical dysplasia by outpatient electrocauterization. Am J Obstet Gynecol. 1968; 101: 200–205.
Charles EH, Savage EW. Cryosurgical treatment of cervical intraepithelial neoplasia. Ob-stet Gynecol Surv. 1980; 35: 539–548.
Popkin DR, Scali V, Ahmed MN. Cryosurgery for the treatment of cervical intraepithelial neoplasia. Am J Obstet Gynecol. 1978; 130: 551–554.
Crisp WE, Smith MS, Asadourian LA, et al. Cryosurgical treatment of premalignant disease of the uterine cervix. Am J Obstet Gynecol. 1970; 107: 737–742.
Benedet JL, Miller DM, Nickerson KG, et al. The results of cryosurgical treatment of cervical intraepithelial neoplasia at one, five, and ten years. Am J Obstet Gynecol. 1987; 157: 268–273.
Bryson SCP, Lenehan P, Lickrish GM. The treatment of grade 3 cervical intraepithelial neoplasia with cryotherapy: an 11-year experience. Am J Obstet Gynecol. 1985; 151: 20 1206.
Syrjanen K, Kataja V, Yliskoski M, et al. Natural history of cervical human papillomavirus lesions does not substantiate the biologic relevance of the Bethesda system. Obstet Gynecol. 1992; 79: 675–682.
Whiteley PF, Olah KS. Treatment of cervical intraepithelial neoplasia: experience with the low-voltage diathermy loop. Am J Obstet Gynecol. 1990; 162: 1272–1277.
Prendiville W, Cullimore J, Norman S. Large loop excision of the transformation zone (LLETZ). A new method of management for women with cervical intraepithelial neoplasia. Br J Obstet Gynecol. 1989; 96: 1054–1060.
Gunasekera PC, Phipps JH, Lewis BV. Large loop excision of the transformation zone (LLETZ) compared to carbon dioxide laser in the treatment of CIN: a superior mode of treatment. Br J Obstet Gynecol. 1990; 97: 995–998.
Luesley DM, Cullimore J, Redman CWE, et al. Loop diathermy excision of the cervical transformation zone in patients with abnormal cervical smears. Br Med J. 1990; 300: 1690 1693.
Turner RJ, Cohen RA, Voet RL, et al. Analysis of tissue margins of cone biopsy specimens obtained with “cold knife,” CO2 and Nd:YAG lasers and a radiofrequency surgical unit. J Repro Med. 1992; 37: 607–610.
Wetchler SJ. Treatment of cervical intraepithelial neoplasia with the CO2 laser: laser versus cryotherapy. A review of effectiveness and cost. Obstet Gynecol Surv. 1984; 39: 469–473.
Mclndoe GA, Robson MS, Tidy JA, et al. Laser excision rather than vaporization: the treatment of choice for cervical intraepithelial neoplasia. Obstet Gynecol. 1989; 74: 165–168.
Tabor A, Berget A. Cold-knife and laser conization for cervical intraepithelial neoplasia. Obstet Gynecol. 1990; 76: 633–635.
Bostofte E, Berget A, Larsen F, et al. Conization by carbon dioxide laser or cold-knife in the treatment of cervical intraepithelial neoplasia. Acta Obstet Gynecol Scand. 1986; 65: 199–202.
Kristensen GB, Jensen LK, Holund B. A randomized trial comparing two methods of cold-knife conization with laser conization. Obstet Gynecol. 1990; 76: 1009–1013.
Delmore J, Horbelt DV, Kallail KJ. Cervical conization: cold-knife and laser excision in residency training. Obstet Gynecol. 1992; 79: 1016–1019.
Howell R, Hammond R, Pryse-Davies J. The histologic reliability of laser cone biopsy of the cervix. Obstet Gynecol. 1991; 77: 905–911.
Fowler JM, Davos I, Leuchter RS, et al. Effect of CO2 laser conization of the uterine cervix on pathologic interpretation of cervical intraepithelial neoplasia. Obstet Gynecol. 1992; 79: 693–698.
Larsson G, Alm P, Grundsell H. Laser conization versus cold-knife conization. Surg Gynecol Obstet. 1982; 154: 59–61.
Baggish MS. A comparison between laser excisional conization and laser vaporization for the treatment of cervical intraepithelial neoplasia. Am J Obstet Gynecol. 1986; 155: 39–44.
Sprang ML, Isaacs JH, Boraca CT. Management of carcinoma in situ of the cervix. Am J Obstet Gynecol. 1977; 129: 47–50.
Larsson G, Gullberg B, Grundsell H. A comparison of complications of laser and cold-knife conization. Obstet Gynecol. 1983; 62: 213–217.
Schantz A, Thormann L. Cryosurgery for dysplasia of the uterine ectocervix: a randomized study of the efficacy of the single-and double-freeze techniques. Acta Obstet Gynecol. Scand 1984; 63: 417–420.
Paraskevaidis E, Jandial L, Mann EMF, et al. Pattern of treatment failure following laser for cervical intraepithelial neoplasia: implications for follow-up protocol. Obstet Gynecol. 1991; 78: 80–83.
Hirai Y, Nishide K, Yamauchi K, et al. Cytomorphologic, cytometric and histomorphologic observations after laser therapy for cervical lesions. J Repro Med. 1992; 37: 267–272.
Andersen ES, Nielsen K, Larsen G. Laser conization: follow-up in patients with cervical intraepithelial neoplasia in the cone margin. Gynecol Oncol. 1990; 39: 328–331.
White CD, Cooper WL, Williams RR. Cervical intraepithelial neoplasia extending to the margins of resection in conization of the cervix. J Repro Med. 1991; 36: 635–638.
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Dolan, J.R., Moen, M.D. (1993). Management of the Abnormal Pap Smear. In: Knaus, J.V., Isaacs, J.H. (eds) Office Gynecology. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-4340-3_2
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