Correlating cone biopsy histology with operative indications

Objective: To correlate operative indications for and histologic findings of cold knife cone biopsy since introduction of the Bethesda system for classification of cervical cytology. Methods: Patients undergoing cold knife conization of the cervix at adjacent urban medical centers were identified from operating logs. Data on indication and outcome were tabulated retrospectively for 294 women. Results: Cone biopsy indications were sometimes multiple and included dysplastic or malignant endocervical curettage (ECC) in 66%, inadequate colposcopy in 48%, cytologic:histologic discrepancy in 16%, and suspicion of invasive cancer on biopsy in 1% of cone biopsies. For 8% of patients, none of these indications were found. The respective proportions of women with benign findings or atypical, low-grade dysplasia, high-grade dysplasia, or cancer was 16, 15, 65, and 3% for positive ECC, 26, 16, 54, and 4% for inadequate colposcopy, 22, 17, 59, and 0% for discrepancy, and 0, 0, 100, and 0% for suspicion of cancer on cytology. Outcomes were significantly worse among women with positive ECC (OR = 2.1, P = 0.006). Conclusions: The likelihood of identifying high-grade lesions in cone biopsy specimens is high, especially among women with a positive ECC, but the risk of cancer is low.