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Notes: Objective To assess the efficacy of cervical conization as primary management of cervical intraepithelial glandular neoplasia (CIGN).Design A multicentre prospective cohort study.Setting CRC Clinical Trials Unit, Birmingham.Subjects 84 women registered with the Unit between May 1986 and January 1989. After excluding 33 women, 51 who had been managed in accordance with the described protocol and had the presence of CIGN confirmed by central review of diagnostic histopathological material were included in the study.Intervention/Protocol Women with CIGN diagnosed on a cervical cone specimen were managed in accordance with a specific protocol: (a) women with negative cone margins were managed conservatively and followed up with regular cervical cytological and colposcopic examinations; (b) women with involved cone margins were managed by hysterectomy.Main outcome measures Presence or absence of CIGN at cone margins, results of cervical cytological examinations following conization, results of histopathological assessment of any surgical specimens taken after initial cone biopsy.Results Of the 51 women with confirmed CIGN, managed by conization, 14 (27%) were aged 30 or less and 15 (29%) were nulliparous. Thirty five women who had a cone biopsy showing margins free of CIGN have been managed by conization alone. After a median follow-up period of 12 months there is no apparent residual CIGN or invasive disease in this group. Thirteen women have had further surgical procedures (according to protocol) and two have had a hysterectomy for benign gynaecological disorders. Eight further procedures were carried out because the original cone biopsy had margins involved with CIGN, and only one of them was found to have residual CIGN. The other five procedures were carried out solely because of abnormal cytology, only one of them had a diagnosis of CIN 1. A total of 10 women had cytological abnormality following cone biopsy, one had CIGN, one had CIN 1 and a third had CIN 3.Conclusions Our preliminary data suggests that when a diagnosis of CIGN is made upon a cone biopsy, further surgery is unnecessary in those women in whom the margins of the cone specimen are free of disease. Cytological and colposcopic follow up, including cytological sampling of the endocervical canal, is recommended for these women.

Notes: Between 1978 and 1985, 19 cases of adenocarcinoma-in-situ and 12 cases of glandular atypia have been identified at the Birmingham and Midland Hospital for Women. In 19 cases an associated dysplastic squamous element was identified, 20 of 28 pre-diagnosis smears correctly predicted a glandular lesion, 5 of 17 colposcopically directed biopsies predicted the findings in a larger biopsy (cone biopsy or hysterectomy). Colposcopy provided no additional information with regard to diagnosis. Twelve of 13 patients managed by cone biopsy and 16 of 17 by abdominal hysterectomy have been treated successfully as defined by subsequent normal cytology.

Notes: Out of 951 smears taken from women attending a hospital cytology clinic, 122 were found to be of poor quality. Twenty-eight percent of these were associated with clinical and/or cytological atrophy, and in 91% of these the main adverse factor affecting smear quality was scantiness. The relative risk of obtaining a scanty smear was found to be 4.8 times greater in women in whom clinical atrophy was identified when compared with those with no atrophy. It is suggested that a reduction in the number of scanty, and hence potentially inadequate, smears in the screening programme may be achieved by the use of more appropriate sampling implements in all women in whom there is clinical evidence of atrophy. Further review of alternative sampling methods is indicated.

Notes: Background:  Hyperplastic mesonephric remnants are an incidental finding in occasional uterine or cervical surgical specimens. We describe three cases in which such remnants were postulated to be the source of abnormal glandular cells in cervical smears.Cases:  In all three cases abnormal glandular cells were seen in cervical smears. Subsequent histology showed the presence of hyperplastic mesonephric remnants that communicated with the endocervical canal and were likely to be the source of the abnormal glandular cells. We believe that the key features of these cells, which may aid their distinction from other causes of glandular abnormalities, are their loose clustering, lack of significant anisocytosis and cuboidal outlines.Conclusion:  We aim to document mesonephric hyperplasia as a possible source for abnormal glandular cells in cervical smears.

Notes: Background:  The vaginal vault smear is a test for cellular atypia in women who have undergone a hysterectomy. In asymptomatic women the test has poor sensitivity and specificity. Current guidelines recommend: vault smears should not be used after hysterectomy for benign pathology; two vault smears (6 and 12 months postsurgery) should be taken when there is evidence of completely excised CIN II/III in the specimen.Aim:  To describe primary health care professionals’ self-reported knowledge and behaviour relating to the use of vault smears.Design of Study:  Questionnaire.Setting:  South Birmingham.Methods:  Postal questionnaire survey to primary health care professionals (general practitioners and practice nurses, n = 424).Results:  Response rate 80.0%, completed response rate 68.9%. Mean knowledge score was 7.3 out of possible 12 (SD 1.9); range 0–10. No significant differences were observed between GPs and practice nurses in knowledge scores, although differences were noted in the frequency of performing vault smears. An inverse relationship was observed between frequency of performing vault smears and level of knowledge about the test. There was a positive association between requesting further information and the ‘knowledge score’. Only 11% correctly answered a question based on current guidelines.Conclusions:  Knowledge of current guidelines was poor. Those who undertook fewest vault smears appeared best informed. This suggests that if all primary care professionals practised according to current guidelines, the number of vault smears performed may be reduced. Unnecessary vault smears may cause additional anxiety in women and have financial consequences for the NHS.

Notes: For the cytologist and clinician alike, glandular lesions pose possibly the greatest challenge in cervical screening. Worldwide, with increasing confidence in cytological prediction, terminology is evolving. In the UK, with the adoption of liquid based methods, the technical aspects of cervical cytology are being addressed, it is now time to standardise our terminology in glandular reporting. Consideration of the cytological complexity, clinical needs and international protocols is essential in this endeavour.