Preinvasive carcinoma of the cervix

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The clinical usefulness of the vaginal smear

The chief value of the vaginal smear is as a simple, rapid means of accelerating the diagnosis of cancer in those cases in which the presenting symptoms or lesions are not sufficiently alarming to provoke immediate surgical investigation. Carcinoma of the endocervix, carcinoma in situ, and carcinoma existing together with inflammatory and scarifying lesions are most likely to be discovered by the method. The very early ulcerative malignancy, before the fibrous proliferative reaction produces the classical raised edge and granular base, also has been detected on the smear taken just before the cautery was applied. The small nubbin without ulceration also yields malignant cells. These lesions almost always include the surface epithelium. The positive smear has induced the immediate repetition of biopsy or curettage when the first sections have not confirmed a clinical suspicion. It can prevent temporizing when there is an easy explanation (such as estrogen administration or menopausal irregularity) for spotting and metrorrhagia. Examination of smears has corrected a number of false impressions caused by poor visualization. The smear method is irreplaceable for the early diagnosis of recurrence after radiation. Salvage of the patient is rarely to be expected from such a discovery, but planning of palliative therapy is greatly aided.