[Colposcopy in cases of carcinoma in situ].
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In an attempt to evaluate the accuracy of cytologic and colposcopic findings (alone and in combination) in detecting preclinical lesions of the uterine cervix, diagnoses made in 170 consecutive patients referred for colposcopic examination at Nassau Hospital because of an abnormal Papanicolaou smear were reviewed. We found that of the investigative methods available prior to biopsy, a combined cytologic and colposcopic evaluation is preferred since it is highly accurate in predicting the degree of severity of a lesion (84.6% of all cases reviewed) and, in our experience, eliminates the problem of false negatives, which are encountered when either method is used to the exclusion of the other.
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A total of 66 women with cervical intraepithelial neoplasia extending into the endocervical canal were investigated by endocervical curettage, contact endoscopy, and conization biopsy of the cervix. Although atypical epithelium was obtained in only 8 women by blind endocervical curettage, contact endoscopy identified 42 instances of disease of equal or greater magnitude than determined by the original ectocervical colposcopic evaluation. These findings were subsequently confirmed by conization biopsy. As the 6-mm contact hysteroscope may easily be inserted into the pregnant cervix, sufficient reassurance may be gained to avoid endocervical curettage or cone biopsy and thus to avoid the hazard of major hemorrhage and/or pregnancy interruption.
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