The incomplete cone in carcinoma in situ of the cervix: A prospective study in a developing country

The diagnostic procedures and treatment of carcinoma in situ and severe dysplasia of the cervix are becoming more conservative. In a developing country special problems make such an approach more hazardous. During a 15-month period the diagnosis in 25 of 206 patients (12,1%) with a smear positive for carcinoma in situ could not be confirmed histologically at Tygerberg Hospital. A prospective study of 147 cases (71,4%) in which the diagnosis was confirmed revealed that they were mostly young patients of relatively high gravidity. The difficulty of assessing the completeness of a cervical cone and of evaluating a postconization smear is confirmed. The danger of a too conservative approach in our patients is confirmed by the fact that only 8,2% of patients came for regular follow-up examinations and that 34,7% did not return for follow-up smears. The high incidence of total hysterectomy (51,7%) as the definitive form of treatment is defended, and a more conservative future approach of confirming the diagnosis and reducing the incidence of cervical conization is suggested.