AVOIDING CONIZATION FOR INADEQUATE COLPOSCOPY - SUGGESTIONS FOR CONSERVATIVE THERAPY

OBJECTIVE: To determine if conservative treatment can safely be offere d to patients with cervical intraepithelial neoplasia (GIN) and inadeq uate colposcopic examination. STUDY DESIGN: We reviewed the charts of 733 evaluable cone biopsies of the cervix performed for CIN at the Uni versity of Texas Medical Branch at Galveston from January 1981 to Sept ember 1990. RESULTS: Of 371 conizations that indicated inadequate colp oscopy, there were 62 cases that fulfilled all the fol lowing conditio ns: cytologic smear suggesting CIN 2 or less, negative endocervical cu rettage (ECC) and cervical colposcopic biopsy showing CIN 2 or less. P athologic examination of the cone biopsy specimen in these 62 cases re vealed no dysplasia in 29.0%, CIN 1 in 16.1%, CIN 2 in 37.0%, CIN 3 in 17.7%, and no microinvasive or invasive lesions. Pathologic examinati on of the cone specimens of 309 patients with any high-risk factor-sme ar suggesting CIN 3 ou invasive disease, colposcopic biopsy showing CI N 3 or positive ECC-revealed no dysplasia in 11.9%, CIN 2 in 11.3%, CI N 2 in 16.8%, CIN 3 in 49.8%, microinvasive carcinoma in 5.5% and fran kly invasive carcinoma in 4.5%. CONCLUSION: Conservative therapy may b e offered to patients with inadequate colposcopy, CIN 1-2 on both biop sy and cytology, and negative ECC without overlooking either invasive or microinvasive carcinoma. With these criteria, 16.7% of patients wit h an inadequate colposcopy in our study could have avoided cone biopsy .