20-YEAR EXPERIENCE OF FOLLOW-UP OF THE ABNORMAL SMEAR WITH COLPOSCOPY AND HISTOLOGY AND TREATMENT BY CONIZATION OR CRYOSURGERY

During the period 1967 to 1977, 1466 women with Pap smears suggesting cervical epithelial neoplasia (CIN) II or worse were evaluated by colposcopy, portio biopsy, and endocervical curettage. Women who had CIN III were treated first by conization and later by cryosurgery. Cytological diagnosis was inaccurate compared to colposcopical and histological diagnosis, with 27% having a worse histological diagnosis. In 22% of the cases histology was two degrees less or worse than suggested by cytology. Presence of atypical vessels was associated with invasive cancer in 17% of cases. A total of 635 patients were treated by conization. After an average follow-up of 10 years, the cure rate was 96% compared to 87% by cryosurgery (104 cases). Hysterectomy was, mainly because of old age, performed on 154 patients; the cure rate was 97%. Although most treatment failures occurred within the first 5 years, some were seen after as long as 15-20 years. © 1990.