Cone biopsy during pregnancy.

Under a diagnostic schema that used cervical conization liberally for evaluating women with abnormal Papanicolaou smears, 82 pregnant patients underwent conization. Fifteen had significant morbidity related to cervical bleeding. The uncorrected perinatal mortality was 44.1/1000. Sixty-one cone biopsies, performed before colposcopy was introduced into the schema, uncovered 2 cases of previously undiagnosed invasive carcinoma. Among 21 patients who underwent colposcopy before conization, 1 case of microinvasive carcinoma was diagnosed. During the study, 15 patients with frankly invasive carcinoma were identified, 9 by punch biopsy of a gross lesion, 2 by cone biopsy without prior colposcopy, and 4 by colposcopically directed punch biopsy. As a result of the review, the diagnostic schema has been changed so that biopsy is used less often on pregnancy patients.

The colposcopy clinic in a residency training program. Five years' experience with colposcopically directed biopsies followed by conization or hysterectomy.

Five hundred fifty-four patients with abnormal cytologic smears were screened in a special clinic by gynecology residents under faculty supervision using colposcopy and biopsies. Two hundred fifty patients who were evaluated by colposcopy subsequently had conization or hysterectomy. Colposcopically directed biopsies were accurate (comparable to the surgical specimen) in 92%. Three patients had invasive cancer high in the endocervical canal that was found by conization after endocervical curettage and colposcopy had indicated less-severe disease. Persistent or recurrent dysplasia was found in approximately 5% after conization and in none after hysterectomy. Because 23% of patients were lost to follow-up after treatment and an additional 19% had inadequate follow-up, management of CIN III with local destruction (cryocautery, electrocautery, laser) does not seem advisable.