Impact of a cytologic screening program on a gynecologic malignancy service

The accuracy of a punch biopsy diagnosis of cervical neoplasia in patients with abnormal cytologic findings is assessed. Cervical punch biopsies were performed in 859 patients, and 258 had subsequent cold‐knife conizations. Invasive carcinoma was diagnosed in 189 patients by the initial cervical biopsy. Carcinoma in situ was noted in 194 patients, and this diagnosis was confirmed by conization in 75% of the cases. Pathology of a lower rank was found in 17%, microinvasion in 6%, and frank invasion in 2%. Dysplasia was diagnosed by biopsy in 246 patients. Of the cold‐knife conizations performed in 66 cases of dysplasia, 40% confirmed the dysplastic lesion, 40% revealed carcinoma in situ, 10% chronic cervicitis, 3% microinvasion and 2% invasive carcinoma. A comparative analysis of the biopsy, conization and hysterectomy findings is presented. Multiple cervical punch biopsies from properly selected sites aided by Schiller stain and including an adequate area of the squamocolumnar junction are useful as the initial diagnostic procedure in women with abnormal cytology or suspicious cervical lesions. Conization is indicated if biopsy or cytology findings raise suspicion of a higher rank of neoplasia. All patients with carcinoma in situ and severe dysplasia on biopsy must have subsequent conizations performed. The postmenopausal female with any degree of dysplasia on biopsy and patients with repeated abnormal cytologic findings despite negative biopsy results must also undergo conization.

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