Decision-making in the colposcopy clinic - a critical analysis

Objective: To consider the omission of several diagnostic steps from the ma nagement of patients with high-grade squamous intraepithelial lesion (SIL) by analyzing the role of each step on the choice of treatment. Study design : Each diagnostic procedure was correlated to the treatment and outcome in 87 women with high-grade SIL. Treatments considered were large loop excisio n of the transformation zone (LLETZ), cold knife conization, and CO2 laser vaporization. Results: Unsatisfactory colposcopy (P less than or equal to 0 .01) and positive endocervical curettage (ECC) specimen (P less than or equ al to 0.01) were essential for choice of treatment. CIN2 diagnoses of the p reoperative cervical biopsy were rediagnosed as CIN3 based on the surgical specimen in 57% of the cases. The margins of 33 and 23% of surgical specime ns removed by LLETZ or knife conization, respectively, displayed CIN involv ement. Forty and 47% of these patients, respectively, later developed recur rent GIN. Conclusions: Omission of colposcopy and ECC could have resulted i n sub-optimal treatment in many cases. Excision by LLETZ or knife conizatio n is recommended for cases of CIN2 and CIN3. Follow up is imperative for pa tients with involvement of the margins. (C) 1999 Elsevier Science Ireland L td. All rights reserved.