The value of diagnostic conisation procedure for detection of high- grade lesions in the women with longterm cytology findings and unsatisfactory colposcopy

Background The risk of development high-grade lesions and invasive cervical cancer increases with age. Unsatisfactory colposcopy, where the area of interest is not visible is a common area of clinical uncertainly due to the lack of clear evidence and guidance. In cases of apparent long-term discordance between cytology and unsatisfactory colposcopy (transformation zone type III) a biopsy adequate to make the diagnosis is essential. Endocervical curettage can not be implemented due to cervix stenosis. In cause of unclear findings and append request the patients the cone excision were indicated.

Method We analyzed retrospectively 776 patients after the cone procedure in group of women between 22 and 80 years old. About 11% (N=86) of all procedures were diagnostic conisations. The main cause for undertaking this medical procedure was pathologically pap smear Pap III D2 (66%) and HPV persistence over 5 Years (15,01%). Colposcopy was due to type III transformation zone in over of 99 % unsatisfactory. In our group after the conisation procedure showed in 21 % of cases (N=26) any pathologically abnormalities, in 6 % of the woman were detected CIN 2+ lesions. We didn’t detect any carcinoma. Simoultanously 4 cases of VaIN II-III were identify.

Conclusion There is insufficient evidence to support the use of cone biopsy in the triage of high grade intraepithelial lesions in the patients with discrepancy between cytology findings and unsatisfactory colposcopy. The consequent indication for the diagnostic cone procedure must be taken in order to prevent the over-treatment.

Publication History

Article published online:
07 October 2020