Role of cytological examination
The main task of cytological examination (taking smears or scrapes) is not to confirm the fact of healing, but rather oncological vigilance. For diagnosing the epidermization process itself or concomitant endometriosis, this method is considered of low informativeness. However, it is absolutely essential in order to rule out cellular atypia that may develop in the non-keratinizing stratified squamous epithelium.
Colposcopy and differential diagnosis
Colposcopy serves as the primary tool for differential diagnosis. During the examination, the physician must distinguish developing Nabothian cysts from a number of other pathological conditions. The differential diagnosis list includes:
- Ectopia;
- Erythroplakia;
- Cervical polyps;
- Ectropion;
- Cervical endometriosis.
Clinical assessment of endocervicosis healing
During a standard speculum examination, areas with different types of epithelial cover have distinct visual differences, which helps assess the completeness of endocervicosis healing:
- Areas of ectopia. Covered by simple columnar epithelium. Visually, they have a pronounced red color. This occurs because the richly vascularized subepithelial layer shows clearly through the thin single-layer sheet of cells.
- Zones of completed epidermization. Represented by mature stratified squamous epithelium. They acquire the usual gray tint characteristic of normal mucosa, as the dense multi-layered sheet obscures the vascular pattern.
Indications for histological verification
If the results of cytology or colposcopy are questionable, histological verification via biopsy is used. This method is indicated in two main cases:
- Targeted suspicion of concomitant dysplasia or cellular atypia detected at previous stages;
- An unclear or doubtful colposcopic picture that does not allow for unambiguous differentiation of the process.
Color tells the epithelium apart: Columnar — Colored (red due to vessels), Squamous — Faded (gray).
Class and exam questions
Can the diagnosis of "healing endocervicosis" be made based solely on a cytological smear?
No, cytology is of limited informativeness for assessing the epidermization process. Its main purpose in this case is to rule out cellular atypia.
Why do areas of columnar epithelium appear red upon examination?
The red color is caused by the vascular subepithelial layer showing through the thin simple columnar epithelium.
With which pathologies must Nabothian cysts be differentiated during colposcopy?
Differential diagnosis is performed with ectopia, erythroplakia, ectropion, cervical endometriosis, and cervical polyps.
In which cases is a biopsy mandatory?
Histological verification is required for an unclear colposcopic picture or justified suspicion of dysplasia and atypia.
What else to study on this topic
- Cervical ectopia and ectropion
- Erythroplakia
- Cervical polyps
- Cervical endometriosis
- Mechanisms of Nabothian cyst formation
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