Severe cervical dysplasia. Control by biopsies or primary conization? A comparative study.

Abstract

During the period 1967-75 severe cervical dysplasia was diagnosed in 87 consecutive cases by means of colposcopically directed biopsies of the portio and by cervical curettage. Thirty-eight of the patients were treated, 3-6 weeks after diagnostic biopsy, by conization (conization group) and subsequently followed with smears and colposcopy. The remaining 49 patients (the biopsy group) were followed up at regular intervals by colposcopically directed biopsies of the portio and cervical curettage. The follow-up period for all 87 patients ranged from 9 to 106 months, mean 47.6 months. The groups were comparable with respect to the most important epidemiological factors. During the follow-up period progression to carcinoma in situ and to microinvasive carcinoma was found in 57.1% of the biopsy group but in 0% of the conization group. Of the whole material, 69 patients had conization (the 38 patients of the conization group plus 31 of the biopsy group). In 3 cases (4.35%) the cone diagnosis was 1 grade more serious than the biopsy diagnosis. The mean transit time of progression from severe dysplasia to CIS/MIC was 12-15 months. It is concluded that severe dysplasia is a rapidly progressing state which can be safely diagnosed by colposcopically directed biopsies of the portio and cervical curettage and effectively treated by conization. In view of the fact that not less than 32.7% of the cases with severe dysplasia in the biopsy group regressed during follow-up, we recommend that the diagnosis be established by portio biopsies and cervical curettage, twice with an interval of 3 months to restrict the number of superfluous conizations.