From the Guidelines
The presence of squamous and endocervical epithelium without underlying stroma in a cervical biopsy sample is considered inadequate for diagnostic purposes, necessitating a repeat biopsy to obtain sufficient tissue for accurate evaluation. This is because the absence of stromal tissue hinders the assessment of potential invasion and the evaluation of pathological processes that specifically affect the stroma or the epithelial-stromal junction 1. The specimen's composition, lacking the deeper tissue layers, limits the ability to diagnose cervical dysplasia or malignancy accurately, as these conditions often involve changes in the deeper tissue layers.
Key Considerations
- The lack of underlying stroma prevents comprehensive evaluation of the tissue sample, particularly for assessing invasion and staging in cases of suspected cervical neoplasia.
- A repeat biopsy is essential to obtain adequate tissue that includes the underlying stroma, using techniques such as cervical punch biopsy or endocervical curettage to ensure sufficient depth of the sample.
- The presence of squamous and endocervical epithelium without stroma is unsatisfactory for diagnostic purposes, highlighting the need for careful sampling and examination techniques in cervical biopsy procedures 1.
Implications for Patient Care
- Patients with inadequate biopsy samples should undergo repeat procedures to ensure accurate diagnosis and appropriate treatment planning.
- Clinicians should be aware of the importance of obtaining sufficient tissue, including underlying stroma, for comprehensive evaluation and diagnosis of cervical lesions.
- The management of cervical lesions, as outlined in guidelines such as those from the American College of Physicians 1, emphasizes the need for careful consideration of biopsy results and the potential need for repeat sampling to ensure accurate diagnosis and effective treatment.
From the Research
Squamous and Endocervical Epithelium
- The squamous and endocervical epithelium are two types of epithelial tissues found in the cervix, with distinct characteristics and functions 2.
- Squamous epithelium is a type of stratified epithelium, composed of multiple layers of cells, and is found in the ectocervix 3.
- Endocervical epithelium, on the other hand, is a type of simple columnar epithelium, composed of a single layer of cells, and is found in the endocervix 2.
Relationship with Underlying Stroma
- The squamous and endocervical epithelium are typically separated from the underlying stroma by a basement membrane 2.
- However, in some cases, the epithelium may be found without underlying stroma, such as in fragments of cervical tissue found in uterine curettings 4.
- In these cases, the epithelium may still be evaluated for abnormalities, such as dysplasia or carcinoma in situ 4.
Abnormalities and Precancerous Lesions
- Abnormalities in the squamous and endocervical epithelium can be precancerous, such as cervical intraepithelial neoplasia (CIN) or adenocarcinoma in situ (AIS) 5, 2, 6.
- These abnormalities can be detected through cytological screening, colposcopy, and biopsy 5, 2.
- The presence of high-risk human papillomavirus (HPV) is a significant risk factor for the development of these precancerous lesions 5, 2.