Cytologic examination to detect clear cell adenocarcinoma of the vagina orcervix

Objective. The aim of this study was to determine the sensitivity of cytopa thologic examination for the detection of vaginal or cervical clear cell ad enocarcinoma (CCA). Methods. Systematic collection in the Dutch automated nationwide pathology archive of all cytology and histology data of women with CCA, born in The N etherlands after 1947 was performed. All cytologic examinations within 2 ye ars prior to histological diagnosis of CCA were included. Results. Ninety patients with CCA have been registered. Forty-nine of these patients had cytologic examinations prior to histology. Eighty-five percen t of cervical CCAs were preceded by a positive cervical smear. One hundred percent of vaginal CCAs were preceded by a positive vaginal smear. Cervical smears are relatively insensitive to detect vaginal CCA, Vaginal smears we re often omitted. Only 2 apparently false-negative smears were found. The m ean numbers of smears in diethylstilbestrol (DES)exposed and nonexposed wom en were minimally different: 1.0 and 0.8, respectively. This suggests an on ly modest impact of the awareness of DES as a risk factor. FIGO tumor stage I was preceded more frequently by cytology than the higher tumor stages. Conclusion. The majority of CCA cases can be detected at an early stage by yearly clinical and cytological examinations, which must comprise cervical as well as vaginal sampling. Since CCA may also occur in postmenopausal wom en, for the purpose of secondary prevention of CCA regular cytologic examin ations of DES-exposed women must be continued after menopause. (C) 1999 Aca demic Press.