Management of the suspicious cytologic cervical smear to the final diagnosis and therapy

The diagnostic procedures dictated by suspicious cytologic reports are described. Mass screening by cytologic techniques has yielded 2–2.5 % of Papanicoloau Class III smears. Of this group 45.1% will be patients with mild or moderate dysplasia and the remainder will have severe dysplasia, carcinoma in situ, and early invasive carcinoma. A reliable diagnosis can be obtained only by histologic examination of serial sections of the cervical cone or of the cervix after hysterectomy. Cervical conization of every patient with a suspicious cytologic smear might expose 45 % of the patients so treated to an unnecessary surgical procedure and would impose a great burden on the gynecologist and the pathologist. By employing colposcopy with selective spot biopsy, or fractional curettage for precise identification of patients with early cervical neoplasia, the number of the conizations can be reduced without increasing the false-negative detection rate.