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Congenital dysplasia of cervical vertebra — Clinical Guidelines

Overview

Congenital dysplasia of cervical vertebrae refers to developmental abnormalities of the cervical spine present at birth, distinct from acquired cervical dysplasia typically associated with HPV infection. This summary focuses on the clinical aspects relevant to colposcopy and cervical cytology management, as the provided abstracts predominantly address cervical dysplasia in the context of HPV-related lesions rather than congenital skeletal dysplasia.

Diagnosis

Key Diagnostic Criteria: Identification through colposcopic examination and cervical cytology (Pap smear).

Recommended Tests: Pap smear, colposcopy, and biopsy for definitive diagnosis.

Grading: Utilizes Bethesda System terminology (e.g., ASC-H, LSIL, HSIL) for cytological abnormalities 2 5.

Special Consideration: Duplicate slides may enhance diagnostic accuracy for atypical cases 2.

Management

First-Line Treatment: Loop electrosurgical excision procedure (LEEP) or cold knife conization for high-grade lesions.

Adjunctive Treatments: Cryotherapy for less severe cases, guided by clinician expertise 11.

Monitoring: Risk-based follow-up strategies post-treatment, tailored to lesion severity and patient risk factors 1.

Special Populations

Pregnancy: Limited direct evidence; crystalline bodies detected in Pap smears during pregnancy may warrant careful evaluation 4.

Elderly and Comorbidities: Management strategies should consider overall health status and potential complications, though specific guidelines are not detailed in provided abstracts.

Key Recommendations

Implement risk-based management strategies for cervical dysplasia detected via colposcopy and cytology, aligning with multidisciplinary guidelines 1 (Evidence: Strong).

Utilize duplicate slides for atypical squamous cell categories to improve diagnostic precision 2 (Evidence: Moderate).

Tailor follow-up and treatment plans based on lesion severity and patient-specific risk factors, ensuring appropriate surveillance post-intervention 1 (Evidence: Strong).

Consider the impact of special populations, such as pregnant women, requiring vigilant monitoring for atypical findings like crystalline bodies 4 (Evidence: Weak).

References

1 Willows K, Selk A, Auclair MH, Jim B, Jumah N, Nation J et al.. 2023 Canadian Colposcopy Guideline: A Risk-Based Approach to Management and Surveillance of Cervical Dysplasia. Current oncology (Toronto, Ont.) 2023. link 2 Zhang S, Kelly B, Hospodar E, Thibodeaux J, Thomas J, Abreo F. The value of duplicate slides on atypical squamous cells, cannot exclude high-grade intraepithelial lesion. Diagnostic cytopathology 2012. link 3 Duvall E. The use of the 'borderline' category in the reporting of cervical cytopathology in the UK: results of a survey conducted under the aegis of the British Society for Clinical Cytology. Cytopathology : official journal of the British Society for Clinical Cytology 2008. link 4 Kapila K, Al-Juwaiser A, Haji BE. Crystalline bodies in Pap smear: a forgotten entity. Diagnostic cytopathology 2007. link 5 Davey DD, Neal MH, Wilbur DC, Colgan TJ, Styer PE, Mody DR. Bethesda 2001 implementation and reporting rates: 2003 practices of participants in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology. Archives of pathology & laboratory medicine 2004. link 6 Ioffe OB, Sagae S, Moritani S, Dahmoush L, Chen TT, Silverberg SG. Symposium part 3: Should pathologists diagnose endocervical preneoplastic lesions "less than" adenocarcinoma in situ?: Point. International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists 2003. link 7 Keesee SK, Domanik R, Patterson B. Fully automated proteomic detection of cervical dysplasia. Analytical and quantitative cytology and histology 2002. link 8 Spitzer M, Apgar BS, Brotzman GL, Krumholz BA. Residency training in colposcopy: a survey of program directors in obstetrics and gynecology and family practice. American journal of obstetrics and gynecology 2001. link 9 Morris KA, Kavanagh AM, Gunn JM. Management of women with minor abnormalities of the cervix detected on screening: a qualitative study. The Medical journal of Australia 2001. link 10 Davey DD, Nielsen ML, Naryshkin S, Robb JA, Cohen T, Kline TS. Atypical squamous cells of undetermined significance. Current laboratory practices of participants in the College of American Pathologists Interlaboratory. Comparison Program in Cervicovaginal Cytology. Archives of pathology & laboratory medicine 1996. link 11 Ferris DG, Crawley GR, Baxley EG, Line R, Ellis K, Wagner P. Cryotherapy precision. Clinician's estimate of cryosurgical iceball lateral spread of freeze. Archives of family medicine 1993. link 12 Puts JJ, Moesker O, de Waal RM, Kenemans P, Vooijs GP, Ramaekers FC. Immunohistochemical identification of Langerhans cells in normal epithelium and in epithelial lesions of the uterine cervix. International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists 1986. link 13 Alessandri LM, Sterrett GF, Pixley EC, Kulski JK. Comparison of peroxidase-antiperoxidase and avidin-biotin complex methods for the detection of papillomavirus in histological sections of the cervix uteri. Pathology 1986. link 14 Homesley HD, Wolff JL, Reish RL, Jobson VW. Evaluating the acquisition of colposcopy skills in an obstetric-gynecologic residency program. The Journal of reproductive medicine 1985. link 15 Chanen W. An endocervical speculum. The Australian & New Zealand journal of obstetrics & gynaecology 1979. link

Congenital dysplasia of cervical vertebra