Towards a more rational policy for colposcopy

The objective of the study was to establish the relationship between the results of positive and abnormal cervical smears and the corresponding colposcopic biopsy results and its relevance to clinical management. A retrospective analysis of linked results was carried out at the Princess Anne Hospital, Southampton. The main outcome measure was the correspondence between a positive or abnormal cervical smear and the related colposcopic biopsy. Colposcopic biopsies were carried out on 1,841 consecutive women. Of these, 1,424 (77.4%) had moderate or severe dyskaryosis on their smears. Of the 1,767 with definitive results on their smear, 1,101 (62%) showed exact correspondence between the cervical smear and the colposcopic biopsy. Ninety-one (26%) of all women with mildly dyskaryotic smears were reported as showing CIN II or CIN III on biopsy. We conclude that women with moderate or severe changes on cervical smear should not be asked to attend for confirmatory colposcopic biopsy prior to treatment, but those with persistent mild changes should be referred for separate diagnostic colposcopy.