Cone biopsy in premenopausal women: why was outpatient management abandoned?

In a 2-year retrospective study, I reviewed the records of 180 premenopausal patients who had had cone biopsy. The purpose of this study was to determine the indications for the procedure in the view of the practicing clinician and to determine whether these young women might have received better treatment as outpatients. In this series, positive findings on endocervical curettage (ECC) in patients with otherwise satisfactory results of colposcopy was by far the leading reason for cone biopsy, and positive findings on ECC did not correlate with occult disease in the canal when the cone specimen was examined. Also, a significant number of women had cone biopsy solely for severe dysplasia, though the literature clearly shows the effectiveness of outpatient management in these cases (eg, using proper cryotherapeutic methods). If ECC is done routinely despite satisfactory results of colposcopic examination and unexpectedly positive results are obtained, I recommend repeat colposcopy with aggressive use of an endocervical speculum and a careful, adequate ECC before abandoning outpatient management. Proper histologic interpretation of ECC in light of all clinical data is essential to avoid unnecessary morbidity.