SUMMARY Sections from 100 cervical biopsy specimens were studied by 12 consultant histopathologists to determine the robustness of the existing pathology terminology and classification. Analysis by K statistics showed good agreement in the diagnosis of CIN 3 and squamous carcinoma but an inability to distinguish accurately between the lesser grades of CIN.It is recommended that the classification be changed to low grade (present CIN 1 and 2) and high grade (present CIN 3) categories alone. There was very poor agreement in the identification ofcellular changes associated with human papilloma virus (HPV) infection.Several novel analytical methods of assessing the severity of uterine cervical intraepithelial neoplasia (CIN) have been proposed,'2 but histological assessment remains the basis for determination oftreatment, clinical management, and subsequent follow up of patients. Although clear criteria for the diagnosis and grading of CIN have been described,3 such assessments are subjective and prone to intra-and interobserver variation.45 The problems of histological assessment have been further complicated by the increasing recognition of human papilloma virus (HPV) infection"7 which may be an aetiological factor in the development of CIN.89 HPV infection may be indicated by koilocytosis and other changes that distort cellular appearances and so may apparently exaggerate the severity of the premalignant appearances ofthe cervical epithelium, particularly in the higher layers-making grading more difficult.It is reasonable that efforts should be made to establish the degree of confidence which can be given to the histological reporting of cervical biopsy lesions by pathologists and to determine the robustness of the existing terminology and classification. We describe the findings of a study of cervical biopsy specimens conducted by a group of 12 pathologists, all of consultant grade, but with varying degrees of experience.Accepted for publication 1 September 1988 Material and methods COMPOSITION OF PANELTwelve histopathologists were invited to join the study with a deliberate attempt by the organisers to obtain a composition representative of Scottish pathology as a whole. The members came from pathology laboratories in Aberdeen (n = 2), Dundee (n = 2), Edinburgh (n = 2), Airdrie (n = 1), Perth (n = 1), Stirling (n = 1) and Glasgow (n = 3) and varied in years of consultant experience (five to 25 years) and nature ofsubstantive post (university staffn = 5: NHS staff n = 7). All the members of the group had undertaken their postgraduate training in Scotland. CLASSIFICATION OF CERVICAL HISTOPATHOLOGYAt the initial meeting current cervical pathology terminology was reviewed and following discussion a proforma was designed for completion after examination of each slide in the circulation. This was modified in a minor way after the first circulation and the final form is shown in the figure. It was decided to keep the classification simple, but to relate it as closely as possible to everyday practice. The following ...

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In response to a 1991 anencephaly cluster in Cameron County, Texas, a surveillance and neural tube defect (NTD) recurrence prevention project for NTDs was implemented in the 14 Texas-Mexico border counties. For 1993-1995, NTD-affected pregnancies were identified at all gestational ages through active surveillance of multiple case-ascertainment sources. There were 87 cases of anencephaly, 96 cases of spina bifida, and 14 cases of encephalocele for respective rates of 6.4, 7.1, and 1.1 per 10,000 live births. Of the 197 NTD case-women, 93% were Hispanic. The overall, Hispanic, and Anglo NTD rates were, respectively, 14.6, 14.9, and 10.6 per 10,000 live births. The NTD rate for El Paso County (9.8 per 10,000), the most northwestern Texas county, was significantly lower (p = 0.001) than the aggregate rate for the rest of the Texas border (17.1 per 10,000). The overall Texas border rate was significantly higher (p < 0.001) than a recently estimated rate of 9.3 for California and minimally higher than a recently adjusted rate of 11.3 for the Metropolitan Atlanta Congenital Defects Program counties (p = 0.052), both of which now reflect all gestational ages. Of the 197 Texas border cases, 85% (168 cases) reached a gestational age of > or =20 weeks. Excluding cases of <20 weeks' gestation in the rate had a more marked effect on reducing the anencephaly rate (4.9 per 10,000) than the spina bifida rate (6.7 per 10,000). A country of birth was known for 153 (83%) of the 184 Hispanic case-women: 63% were born in Mexico; 24%, in Texas; and 11%, elsewhere in the United States. Rates for Mexico-born Hispanic women (15.1 per 10,000) were significantly higher than rates for United States-born Hispanic women (9.5 per 10,000) (p = 0.006).

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Our group had a satisfactory agreement on the distinction of mild from severe dysplasia and on microinvasive carcinoma without any discussion as to histopathological criteria to be used. Clinical management--review endoscopy, repeat cord stripping, radiotherapy and laryngectomy--is in general dependent on histological assessment. Thus the agreement on categories which underpin clinical management is reassuring. However, assessment of moderate dysplasia remains problematic. An attempt to utilize a two grade system--low grade from high grade dysplasia/CIS--may have merit. The implications of the terminology used must be agreed among pathologists and clinicians working closely within clinicopathological cancer groups.

This study was designed to investigate the early development of tumour circulation using a transplantable mouse mammary adenocarcinoma. Tumour cells (10(6] were injected subcutaneously into the flank and groups of treated mice were killed at 24 h intervals up to 12 days; the tumours and surrounding tissues being processed by standard histological methods. Sections of tumour were sub-divided into neoplastic tissue, vessels and connective tissue using computer-assisted morphometric techniques: the host tissue around the tumour was similarly quantified for vessels and connective tissue. With increasing tumour size, the proportion of vessels within tumours rapidly increased to reach a plateau of approximately 1.5 per cent of tumour volume, a 400 per cent increase on the vascular density of normal subcutaneous tissue. Within tumours, vascular density was always higher at the periphery than the centre. The most pronounced increase in vascular density affected the host tissue around the tumour. It is not clear why vascular development is most prominent outwith the tumour when postulated angiogenic factors, such as tumour angiogenesis factor, are presumably released within. Our results imply, however, that tumours acquire their vasculature by infiltration into, and expansion between, a network of newly formed vessels in the surrounding connective tissue.

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