Referral for Colposcopy: Do Our Present Criteria Need Reviewing?

Abstract

Three hundred and seven women referred to a colposcopy clinic over an 11-year period with mildly atypical cervical cytology had a histological diagnosis established by colposcopically directed biopsy. Of the 256 women who had dyskaryosis on the referral smear, 176 (68.8%) had cervical intraepithelial neoplasia (CIN) grade II or III on histology. One woman had microinvasive carcinoma. Fourteen (27.5%) of the 51 women without dyskaryosis had CIN II or III. Of smears taken at the time of colposcopy, 28.9% had normal cytology, although over one third of these women had CIN II or III diagnosed on histology at that time. This poor correlation of mildly atypical cervical cytology and histology suggests that the common practice of relying on cytology alone for the surveillance of women who have already had an atypical smear should be discouraged.