THE CLINICAL COURSE OF CERVICAL-CARCINOMA IN-SITU DIAGNOSED DURING PREGNANCY

Objective. The objective was to determine the frequency with which reg ression or progression of disease without treatment occurred in women diagnosed with squamous cell cervical carcinoma in situ (CIS) during p regnancy. Methods. A retrospective chart review of all women evaluated at the University of Iowa Colposcopy Clinic diagnosed with CIS during pregnancy from 1987 through 1992 was used. Thirty-four women were eva luated during pregnancy, of which 26 also had postpartum evaluation. A ll pathology reports of initial cytology and biopsies, as well as colp oscopic impressions, were reviewed and compared to the same evaluation s postpartum. Results. Of the 26 women evaluated both antepartum and p ostpartum, only 1 was treated (cone biopsy) during pregnancy. She had disease suspicious for microinvasion. She was disease free postpartum, Of the remaining 25, 20 (80%) had persistent disease, 2 (8%) had eith er missed disease or progressive disease postpartum, and 3 (12%) resol ved without treatment at postpartum evaluation, No statistical signifi cance was found between route of delivery and persistence (P = 0.34). No statistical significance was found between smoking and persistence of disease (P = 1.0). In 46% of women the initial cytology was CIN I o r PI, and the initial colposcopic impression was found to underestimat e the severity of the disease in 35% of cases. Two women were found to have invasive disease postpartum. Conclusions, There is a high persis tence rate of CIS complicating pregnancy. Given the relatively high ra te of underestimation of disease severity by both cytology and colposc opic impression, the use of routine biopsy at the time of colposcopy i s recommended. Invasive disease may be encountered on postpartum evalu ation. (C) 1997 Academic Press.