Outpatient therapy: success and failure with dysplasia and carcinoma in situ

Between 1971 and 1980, 385 patients with colposcopic biopsy-proved cervical intraepithelial neoplasia were treated by either the colposcopist or the referring physician by means of cryosurgery, electrocautery, or biopsy excision. All were observed for a minimum of 1 year, 220 between 1 and 2 years, 50 between 3 and 4 years, and 23 for 4 or more years. Therapy failed in 29 in the first year ("failures" proved by tissue examination). The failure rate among the 35 patients with carcinoma in situ was 20%, a rate significantly higher than that seen in 108 patients with severe dysplasia (7 or 6.5%) or in mild and moderate dysplasia (4.4% and 8.5%, respectively). There were 10 "recurrences" seen among those observed for more than 1 year after treatment. In eight instances the histologic severity of the recurrence was more severe than that of the original lesion. The comparative efficacy of cryosurgery and electrocautery and the success and failure rates for the colposcopists and other therapists who had not viewed the lesions prior to therapy are examined.