In the fight against cervical malignancy and its precursors, several adjuvant diag-
In patients with borderline lesions (mild and moderate dysplasias) of the uterine cervix, cytomorphology alone often is not sufficient for the early and definite cytologic detection of malignancy. Cervical dysplasia describes squamous cells or tissues that potentially may lead to malignancy but do not exhibit sufficient evidence for a definite assumption. Resulting from weakness of morphologic criteria to identify malignant transformation in epithelial cells early and unequivocally, dysplasias are not a disease entity. The widely accepted assumption is that the higher the grade of dysplasia is, the higher the probability of progression to carcinoma is.1 However, as a result of insufficient morphologic criteria, neither histologic nor cytologic evaluation can predict whether a lesion will progress to cancer in an individual patient.2 Rates of regression and progression of cervical dysplasia (positive and negative predictive values) are quite different from one study to another. 1 Insufficient interobserver reproducibility in diagnostic cytology and histology represents another dilemma in the microscopic diagnosis of precancerous cervical intraepithelial lesions.Because the diagnosis of cervical squamous intraepithelial lesions (SILs) is not only poorly reproducible but also of limited biologic meaning for the individual patient, the number of resulting control procedures usually is high. These range from repeated cytologic smears and biopsies to unnecessary operations (conizations). Missed early diagnoses of cancers may result from cytomorphologic uncertainties. This also results in unnecessary costs and avoidable anxiety for the patients.In the late 1970s, zur Hausen suggested that there may be an association between human papillomavirus (HPV) and cervical carcinoma.3 Large numbers of subsequent epidemiologic, clinicopathologic, and molecular studies have linked the presence of specific types of HPV to the development of anogenital carcinoma and its precursors. A recent study estimated the worldwide HPV prevalence in cervical carcinomas at 99.7%. 4 Today, it is widely accepted that HPVs play a critical role in the pathogenesis of most cervical carcinomas and their precursor lesions. The infection of cervical epithelial cells with HPV itself is necessary but still insufficient for neoplastic progression. Other factors, especially genetic alterations, are needed to enter into the process of neoplastic transformation.
5Several adjuvant diagnostic methods currently are proposed to increase the diagnostic accuracy and reproducibility of cytology and histology. These range from clinical procedures, like colposcopy, to laboratory methods, like assays for the detection of HPV DNA and HPV typing 6 or DNA image cytometry (DNA-ICM). 1,7,8 In the current review, we focus on the technical performance and application of DNA-ICM in diagnosis and prognosis of cervical SILs and invasive cervical carcinoma.
Biologic BackgroundChromosomal aneuploi...