| A
talk given by Dr Abed Zaitoun at the Thames Valley Cytology
Society meeting held at Stoke Mandeville Hospital on 2nd November
2000.
Dr Zaitoun began
by giving a definition of ‘Borderline changes’ being those
where there is genuine doubt as to whether the nuclear changes are
neoplastic and that there is a great inter- and intra- laboratory
variation in the reporting of borderline changes.
Borderline
nuclear changes mimic or ‘look alikes’ include
- Metaplastic
cells
- Inflammatory
changes
- Dyskaryosis
in metaplastic cells
- Pale dyskaryosis
- Tubo-endometrial
metaplasia
- Atrophic
changes
His study
aims were
- to evaluate
the cytological, colposcopical and histological correlation in
women with BNC
- to evaluate
the completeness of excision of CIN in large loop biopsies LLETZ
- to assess
the residual, recurrent and persistent lesions after treatment.
457 women with
borderline cervical cytology as their first abnormality and who
were subsequently referred for colposcopy and biopsy were studied
and had a mean age of 37.11 years.
The control
group of 457 who were referred to colposcopy with a previous dyskaryotic
smear result, but no previous smear classed as borderline, with
a mean age of 37.06 years were selected.
The colposcopy
findings related to the clinical appearance of the cervix were
- Borderline
group - high percentage of CIN1
- Control
group - high percentage of CIN3
Histological
findings
- Borderline
group - variety of changes from wart virus with or without
CIN to CGIN, the highest percentage was CIN1, followed by CIN2
then CIN3.
- Control
group - high percentage of CIN3
Loop excision
biopsy
- Borderline
group - high percentage CIN3
- Control
group - high percentage CIN3
Completeness
of excision
- Borderline
group - 76.4%
- Control
group - 74.4%
Residual
lesions in the Borderline group compared to the Control group
- Recurrent
and persistent disease was higher in women that had a diagnostic
punch biopsy followed by ablation therapy in comparison with those
that had a loop excision.
- In the Borderline
group there was some moderate dyskaryosis or worse disease seen
in the 5th or 6th follow-up smears compared with low grade dyskaryosis
in the control group.
- There was
no research done on those patients that had no CIN clinically
or on histology.
- It has to
be borne in mind that the disease was being seen at very early
stages.
The data suggests
that women presenting with borderline smears are at a greater risk
of persistent or recurrent disease and that risk continues beyond
5 years.
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