The immediate postconization endocervical smear -: Evaluation of its utility in the detection of residual dysplasia

OBJECTIVE: To determine the diagnostic value gi obtaining an endocervical smear for cytologic examination immediately following cervical conization (by either the loop electrosurgical excision procedure or lar ge loop excision of the transformation zone) in the detection of residual squamous dysplasia. STUDY DESIGN: Thirty-eight cases were identified in which cervical conization was immediately followed by endocervical sampling (most commonly using a brush) and smear. RESULTS: Twenty-one of the 38 postconization endocervical smears (55%) were either unsatisfactory or sub-optimal for evaluation due to cellular distortion (i.e., cautery artifact), degeneration or obscuring blood. Histologic evaluation showed negative endocervical margins in 32 cases (84%) and positive endocervical margins in 6 cases (16%), including both lo io and high grade squamous intraepithelial lesions. The endocervical smears in the 32 cases with a negative surgical margin did not demonstrate evidence of dysplasia. However, in the six cases with histologically positive margins, postconization endocervical smears also failed to identify any evidence of dysplasia. CONCLUSION: Immediate postconization endocervical smears do not appear to be useful for the detection of residual disease in patients undergoing conization for squamous dysplasia of the cervix.