Measurement of endocervical canal extension of the transformation zone on fresh hysterectomy specimens.
OBJECTIVE
Determine the extent of endocervical canal extension of the transformation zone on fresh hysterectomy specimens.


METHODS
After removal for standard gynecologic indications, 201 uteri were evaluated in the pathology accessioning area of a community hospital before formalin fixation. Uteri were opened in standard fashion. The length of the endocervical canal and the distance from the external cervical os to the most cranial extension of the squamocolumnar junction (SCJ) into the canal were measured grossly to the nearest millimeter. Patient age, menopausal status, and indication for surgery were extracted from the pathology consultation sheet.


RESULTS
The upper limit of the SCJ was located within the canal in 188 of 201 cases (93.5%), including 152 of 162 premenopausal cases (93.8%), 25 of 27 postmenopausal cases (92.6%), and 11 of 12 cases of unknown postmenopausal status (91.7%). The mean distance of SCJ extension was 3.8 mm (SD, 2.5 mm), with a trend toward a shorter distance in the postmenopausal women. The SCJ distance was > or =10 mm in 5 of 188 women (2.7%), all of whom were premenopausal, and > or =5 mm in 41 of 188 women (21.8%). Among women with SCJ extension into the canal, the mean canal length was 33.2 mm (SD, 5.4 mm) for the premenopausal women and 28.3 mm (SD, 5.6 mm) for the postmenopausal women (p < .001).


CONCLUSIONS
Postmenopausal status and advancing age were not associated with an increased depth of the SCJ into the endocervical canal. The high rates of unsatisfactory colposcopy reported for postmenopausal women are more likely the result of anatomic changes precluding visualization of the canal rather than the skill of the colposcopist. A device designed to detect cervical intraepithelial neoplasia within the cervical canal should be capable of evaluating to a depth exceeding 5 mm.
Parker
Mary F
MF
Telemedicine & Advanced Technology Research Center, US Army Medical Research & Materiel Command, Fort Detrick, MD 20854, USA. parker@tatrc.org
O'Connor
Dennis M
DM