Colposcopic biopsy and diagnostic conization were performed in patients with abnormal cervical cytology or colposcopic findings, and the patients were subsequently underwent hysterectomy in 168 cases of cervical neoplasia from January, 1988 to
December
1992.
We have analyzed the correlation between the histologic diagnostic results of colposcopic biopsy and those of conization. The correlation between the results of conization and those of subsequent hysterectomy were alos evaluated.
Histological comparison between the colposcopic biopsies and conization samples showed agreement with 70.8% of cases. The dysplasias were underestimated by colposcopic biopsy in 16.7% of cases and overestimated in 12.5% of cases when compared to
the
conization specimen; microinvasive and invasive carcinomas were diagnosed in 20 cases of the conization histology having been underestimated by the preceding colposcopic biopsy.
Thirty two cases (19%) were treated by total abdominal hysterectomy, 102 cases (60.7%) by total hysterectomy with wide cuff vaginal resection, 22 casses(13.1%) by modified radical hysterectomy, and 12 cases(7.1%) by radical hysterectomy
Of the 168 conizations, 129 (76.8%) had clear margins and 39(23.2%) had involved margins. The frequencies of margin involvement in conization specimens had been significantly increased by the severity of cervical lesion(P<0.01).
Residual tumors were found in subsequent hysterectomized specimens in 33 of 168 cases(19.6%). Nine of these had initially clear cone biopsy margin, while 24 cases had in volved margin. Residual tumors were more detectable in the patients with
marginal
involvement by conizationthat those without marginal involvement(P<0.001).
Residual tumors were identified in 1 of 9(11.1%), CIN I or II patients in 13 of 111 (11.7%0 patients of CIN III, in 10 of 37(27%) patients with microinvasive carcinoma, and in 9 of 11 (81.8%) patients with invasive carcinoma. The remaining tumor
lesions
were more associated in the patients with microinvasive and invasive cervical carcinoma than those with cervical preneoplastic lesions(P<0.01).
From the above results, diagnostic conization seems to be essential procedur in patients showing abnormal results by colposcopic directed biopsy, especially in those with CIN III or microinvasion, for the futher proper management of cervical
neoplastic
lesion. The subsequent hysterectomy was recommended in patient with risk of residual tumor and close follow up with cytology and colposcopy was recommended in the postconization patient.
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