Triage of patients with abnormal cervical smears in the absence of colposcopy

In a group of 246 patients with dyskaryotic cervical smears, 144 had 4-quadrant punch biopsies (4Q), while 102 had Lugol's iodine applied to the cervix before punch biopsies were taken from abnormally stained areas (ISD) to determine whether the latter will improve the chances of taking biopsies from areas of cervical intraepithelial neoplasia (CIN). In the ISD group, 66 (64.7%) of the patients had histological confirmation of CIN compared to 56 (38.9%) of those in the 4Q group. Follow-up smears in patients with benign histological findings revealed dyskaryosis in 54.7% and 25% in the 4Q and ISD groups respectively, which is suggestive of a higher false-negative rate in the 4Q group. It is suggested that where facilities for colposcopically-directed biopsy of the cervix is unavailable, patients with abnormal smears should have Lugol's iodine applied before punch cervical biopsies are taken.