INDICATIONS FOR CONE BIOPSY - PATHOLOGICAL CORRELATION

OBJECTIVE: Our purpose was to determine the ability of different indic ations for cone biopsy to predict the presence of disease in the cone specimen and the utility of conization for low-grade disease. STUDY DE SIGN: The records were reviewed of all patients who had an excisional cone biopsy at Queens Hospital Center between 1984 and 1995. Data were gathered regarding cytologic studies, visualization of the transforma tion zone, colposcopically directed biopsy, and endocervical curettage . The indications for the cone procedure were grouped as being for tre atment (biopsy-proved disease) (indication A), discrepancy between cyt ologic and histologic diagnoses (indication B), positive endocervical curettage results (indication C), and transformation zone not fully vi sualized (indication D), and combinations of the above. RESULTS: Two t housand nine hundred sixty-nine records were reviewed. Of these, 604 h ad cone biopsies. Three hundred twenty-three of 355 (91%) cone biopsie s done for indication A alone had disease on the cone specimen (define d as any grade of dysplasia or condyloma). Forty of 47 (85.1%) cone bi opsies done for indication B alone had disease of the cone specimen. F orty-three of 46 (93.5%) cone biopsies done for indication C alone had disease on the cone specimen. Ninety-one cone procedures were done fo r a combination of indications A and D, with 87 (95.6%) showing diseas e on the cone specimen. Thirty-one procedures were done for a combinat ion of indications B and D, with 25 (80.6%) showing disease on the con e specimen. Cone procedures were done on 32 women for a combination of indications C and D, and 30 (93.8%) had disease on the cone specimen. Two cone procedures were done because of the colposcopic appearance a lone; one had high-grade disease on the cone specimen. Age did not hel p to predict the likelihood that disease would be found on the cone sp ecimen. The data were then reanalyzed to determine the likelihood of f inding high-grade disease (cervical intraepithelial neoplasia grades 2 or 3 or invasive cancer) on the cone specimen. Overall, those with pr eoperative high-grade cytologic or histologic characteristics (cervica l intraepithelial neoplasia grades 2 or 3) were much more likely to ha ve high-grade disease (277/371 [74.7%]) than were those with preoperat ive low-grade cytologic or histologic characteristics (condyloma or ce rvical intraepithelial neoplasia grade 1) (49/233 [21.0%]) (p < 0.001) . CONCLUSION: Neither age nor the preoperative grade of disease are go od discriminators of the likelihood that disease will be found on a co nization specimen. However, patients who have high-grade disease on th e preoperative evaluation are much more likely than those with only lo w-grade disease to have high-grade dysplasia or cancer on a subsequent conization.