Conservative management of intraepithelial cervical neoplasia of patients with abnormal cervical cytologic findings is one that provides high diagnostic accuracy, a high cure rate and low morbidity, and, if possible, is economical. Conization, the mainstay of diagnostic and therapeutic regimens over the past 20 years, is associated with substantial morbidity and requires anesthesia and hospitalization, so it is probably too radical a primary procedure for the general population . Reports demonstrating that colposcopy and colposcopically directed punch biopsies, together with repeat cytology,5-7 form an accurate diagnostic regimen have stimulated the use of locally destructive methods such as electrocautery8'9 and cryosurgery10-13 with good results. In this paper we report the results of a prospective trial of colposcopy, colposcopically directed punch biopsies and repeated cytologic investigation, in conjunction with cryosurgery, in 164 patients with intraepithelial cervical neoplasia. Patients and methods From January 1972 patients with Papanicolaou smears showing features consistent with dysplasia or worse were Table I-Age and parity of 164 patients with intraepithelial cervical neoplasia in relation to histologic diagnosis Histologic diagnosis Dysplasia Carcinoma Moderate Severe in situ Variable (n=56) (n=55) (n= 53) Age (yr) Mean 26.7 27 27.2 Range 18-48 17-48 17-43 Parity

0 1 2 3 4

33 8 10 3 2

27 15 9 4 0

27 9 15 2 0

Table 11.-Correlation between cytologic and histologic diagnoses in the 164 patients

Histologic diagnosis Dysplasia Moderate Severe Carcinoma in situ

None 1 1 -

Cytologic diagnosis Dysplasia Mild Moderate Severe 14 4 1

27 15 6

12 32 20

Carcinoma in situ

2 3 26

CMA JOURNAL/MARCH 19, 1977/VOL. 116 641

Table Ill-Number of patients with negative results of follow-up examination (including cytology and colposcopy) after cryosurgery Time after cryotherapy(mo) 1-6 7-12 .3-18 19-24 25-30 31-36 37-42 43-48 Total

No.ofpatients 51 33 17 11 12 13 5 5 147

ber of patients in whom preinvasive cervical neoplasia is discovered at an early stage, it is essential that physicians be aware that conservative methods of diagnosis and therapy are available for these patients. We have shown that such patients can be evaluated with high accuracy by colposcopy, colposcopically directed punch biopsies and repeat cytologic study; we missed no invasive carcinomas. We have also demonstrated that cryotherapy in properly selected patients is highly effective in eradicating intraepithelial cervical neoplasia, and that follow-up colposcopic examination and cytology are reliable in detecting persistence of disease. At present it does not appear that preinvasive cervical neoplasia will develop subsequently in our patients, although the 10- to 15-year results have not been evaluated. It is therefore necessary when choosing a patient for such therapy that she be reliable for continuing follow-up. Thus it appears possible to select and treat effectively patients with intraepithelial cervical neoplasia in a more conservative manner than has heretofore been advocated. However, we stress that because the techniques are new, they should be performed only in specialized centres by persons willing to undertake continuing follow-up of the patients. References

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I, LINDRERO LG,

et al: Conization as treatment of carcinomain-situ of the uterine cervix. Obste: Gynecol 46: 135, 1975

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1. ROTKIN ID: A comparison review of key epidemiological studies in cervical cancer related to current searches for transmissible agents. Cancer Res 33: 1353, 1973 2. DAvIs RM, COOKE JK, KIRK RF: Cervical conization: an experience with 400 patients. Obsie: Gynecol 40: 23, 1972 3. AHLGREN M, INGEMAR55ON

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4. VAN NAGELL JR. PARKER JC, HicKs LP, et

al:

5.

6. 7.

8. 9.

Diagnostic and therapeutic efficacy of

cervical conization. Am J Obste: Gynecol 124: 134, 1976 TOWN SEND DE, OSTERGARD DR, MISHELL DR, et al: Abnormal Papanicolaou smears: evaluation of colposcopy, biopsies and endocer'vical curettage. Ani J Obste: Gynecol 108: 429, 1970 STAFI A, MA'I-rINGLY RF: Colposcopic diagnosis of cervical neoplasia. Obstet Gynecol 41: 168, 1973 OSTERGARD DR, GONDos B: Outpatient therapy of preinvasive cervical neoplasia: selection of patients with the use of colposcopy. Am J Obstet Gynecol 115: 783, 1973 ORiiz R, NEWTON M, TsAI A: Electrocautery treatment of cervical intraepithelial neoplasia. Obsie: Gynecol 41: 113, 1973 HOLLYOCK VE, CHANNEN W: Electrocoagulation diathermy for the treatment of cervical dysplasia and carcinoma-in-situ. Obstet Gyne-

0.

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cervical intraepithelial neoplasia. Obstet Gynecol 41: 501, 1973 12. CRISP WE: Cryosurgical treatment of neoplasia of the uterine cervix. Obseet Gynecol

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col 47: 196, 1976 10. TREDWAY DR, TOWNSEND DE, HOYLAND DN, et al: Colposcopy and cryosurgery in cervical

intraepithelial neoplasia. Am J Obstet Gynecol 114: 1020, 1972 11. CREASMAN WT, WEED JC, CURRY SL, et al: Efficacy of cryosurgery treatment of severe

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39: 495, 1972 Cryosurgical treatment of cervical intraepithelial neoplasia. Obste: Gynecol 42: 881,

13. KAUFMAN RH, STRAMA T, NORTON PK, et al:

1973 14. OSTERGARD DR. TOWNSEND DE, HIROSE EM: Long term effects of cryosurgery of the

uterine cervix. J Cryosurg 2: 17, 1969 tion following cryosurgical treatment for severe dysplasia and carcinoma-in-situ. Reprod Med 11: 68, 1973

15. Go.ros B, OSTERGARD DR: Cytologic evalua-

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