[The clinical morphological concept of origin and course of severe carcinoma in citu (CIN)].

The study was directed to determine objective causes of hypo-diagnostics of neoplastic process of cervix uteri with further development of clinical morphological concept close to understanding and comprehension by practical physicians to avoid diagnostic and tactical errors. The analysis was made concerning diagnostic errors and under-evaluation of degree of neoplasia in 880 patients with CIN of different degree and micro-invasive cancer of cervix uteri. The study also included 187 females with abnormal smears without CIN and cervix uteri cancer. All female patients underwent treatment in polyclinic of the N.N. Blokhin Russian oncological research center in 2006-2011. The correlation of data video-colposcopy pictures and morphology including misfits of results of repeated cytological and histological analysis of limited biopsies and materials of conizations. The study established that in 32% of patients ill-defined cells were detected only in material of endocervix. The rate of under-evaluation of severity of lesions in organic biopsy material increased with decreasing of visibility of transformation zone and increasing of age of patients. In case of fully visible transformation zone type I under-evaluation of degree of neoplasia consisted 12% and reached 20.7% in patients with transformation zone type II and 42.1% in patients with transformation zone type III. The visibility of transformation zone at age older than 30 years is often limited and this occurrence is established in all patents older than 35 years. The objective causes of hypo-diagnostics of neoplasia of cervix uteri in cytological smears and limited biopsy materials include transformation zone type II and especially type III and its age bias with transition zone into cervical channel with concealment there part of more "fresh" and severe lesions. The mentioned causes also embrace involvement of endocervical crypts into neoplastic process and their predominant lesion (in case of absence of ectopia) decreasing information value of smears from ectocervix and limited biopsies and polymorphism of affections as well.