Cervical intraepithelial neoplasia--biopsy methods as AIDS for diagnosis and therapy

Between 1977 and 1995, a total of 1610 patients were admitted to hospital with Pap III, IIID, IVa or IVb. The results of 1182 conisations with cervical abrasion and 428 ectocervical surface scrapings with cervical abrasion were evaluated. The percentage of findings of (CIN II was 35.2% for all cases and 23.3% for conisation alone. No atypical findings or CIN I was seen in 13.9% of all conisation cases. The introduction of a second biopsy method (ectocervical surface scraping (ESS) in 1985 resulted in the reduction of cases with a positive histological finding for conisations of (CIN I from 17.7% (1977-1984, n = 468) to 11.3% (1985-1995, n = 714). Evaluation of combined PA and punch biopsy from the ectocervix assisted by colposcopy was performed in 130 cases. Histological correspondence between the methods was seen in 44.6% of the cases. In 22.3% of the patients the highest CIN degree was seen in the biopsy material obtained under colposcopic observation, while in 33.1% of the cases the highest degree of dysplasia was seen in the material obtained by ectocervical surface scraping. Conisation as the sole diagnostic tool can be replaced by combined and simplified biopsy techniques without prejudice to safety. If only PA is performed, the possibility cannot be ruled out that in individual cases an early-stage invasive cervical carcinoma may be overlooked. Conisation performed without evidence of atypical epithelial structures or only CIN I findings must be regarded as over-treatment. For all CIN III cases, however, conisation remains the most important form of therapy.