Abstract
CO2 laser therapy was performed on 87 cases with cervical intraepithelial neoplasia as a conservative therapy. After irradiation, these cases were followed up using cytodiagnosis, colposcopy and guided punch biopsies. In this study, specifically, changes in cytological findings according to time following irradiation were studied and metric cytoanalysis on tissue repair cells was attempted. The role and meaning of cytodiagnosis using this therapy is reported.
The characteristics of the post-irradiation cytological findings in the time-course are as follows; the appearance of two kinds of fiber-type cells (originating from the neighboring squamous and columnar epithelium), the appearance of tissue repair cells (originating from basal cell hyperplasia and reserve cell hyperplasia), in parallel with these cells, the appearance of atypical tissue repair cells (tentative name), the appearance of metaplastic cells, and after that, normalization.
Regarding cytodiagnosis, another important factor is to differentiate (1) tissue repair cells appearing in almost all the cases, (2) atypical tissue repair cells appearing in approximately 40% of the cases, and (3) dyskaryotic cells appearing in the neoplasia remaining cases. However, modifications, such as inflammation, made it difficult to differentiate the latter two cells in some cases. Therefore, the morphological characteristics of atypical tissue repair cells were analyzed metrically and the following results obtained:(1) aggregation appearance pattern (98.7%), (2) cytoplasm stained pattern; cyanophilic (92.6%), (3) marked anisokaryosis pattern, (4) nuclear membrane pattern: regular (92.7%), (5) chromatin pattern: finely granular (95.4%), and (6) giant nucleoli with a longitudinal diameter of 3.0μ or above eosinophilically stained.
These results demonstrate that the time-course changes in cytological findings and the cytoanalysis of the atypical tissue repair cells are an important index in control of cervical intraepithelial neoplasia when CO2 laser therapy is employed to treat these patients.
In regard to the healing process, cytological and histological findings verify two mechanisms; one, basal cell hyperplasia and another, reserve cell hyperplasia.
There were a small number of insufficiently irradiated cases in whom neoplasia was still noted, however, until now, neoplastic tissues have not been aggravated following irradiation. In such cases, dyskaryotic cells seen on cytodiagnosis and abnormal colposcopic findings served as the standard of diagnosis. That is, residual neoplasia can be diagnosed 2-4 weeks following irradiation because cytological findings show dyskaryotic cells.
