Exam 2 - Cervical cytology results

Question 1

What classification system is used to report cervical cytology results?

Answer 1

Bethesda system (TBS)

• Provides a uniform set of terminology

Question 2

What are the two most common lab result reports that will come back to your clinic regarding cervical cytology?

Answer 2

• Normal - negative for intraepithelial lesion or malignancy
• Squamous or glandular - epithelial cell abnormality

Question 3

What are the four main categories for squamous cell epithelium cervical abnormalities?

Answer 3

• Atypical squamous cells (ACS)
• Low-grade squamous intraepithelial neoplasia (LSIL)
• High-grade squamous intraepithelial neoplasia (HSIL)
• Squamous cell carcinoma

Question 4

What are the two subcategories for atypical squamous cells (ASC)?

Answer 4

• ASC-US - undetermined significance
  
  • A few cells look atypical, no severe dysplasia or cell change
• ASC-H - cannot exclude high-grade squamous intraepithelial lesion
  
  • More concerning than ASC-US, more high-grade severity

Question 5

How would one classify LSIL?

Answer 5

• Lesions on the lower third of epithelial layer
• Encompasses CIN 1 and mild dysplasia

Question 6

How would one classify HSIL?

Answer 6

• CIN 2 (moderate dysplasia) that involves 1/3 to <2/3 of epithelial layer
• CIN 3 (severe dysplasia and carcinoma in situ) that involves 2/3 to full thickness of epithelium

Question 7

How would one classify squamous cell carcinoma?

Answer 7

Penetrates basement membrane of cervical epithelium and infiltrates stromal tissue

Question 8

What are the three main subcategories of glandular cell abnormalities in cervical cancer?

Answer 8

• Atypical glandular cells (AGC)
• Endocervical adenocarcinoma in situ (AIS)
• Adenocarcinoma

Question 9

What other results can be tested with cervical cytology?

Answer 9

Endometrial cells in women 45+ years (indicates possible hyperplasia)

Question 10

Treatment options for cervical cancer

Answer 10

• LEEP/LOOP - first line
  
  • Electrical surgical excision
• Cryocautery
  
  • Destroys tissue so can’t send out to pathology afterwards
• Cold knife cone
• Hysterectomy

Question 11

Which treatment for cervical cancer is best for women with severe dysplasia, CIN 2 or 3, positive abnormal cells in glandular tissues higher up in cervix?

Answer 11

Cold knife cone