Negative cone biopsies. A reappraisal.
OBJECTIVE
To analyze the incidence of negative cone biopsies and evaluate the significance of the findings.


METHODS
The study population consisted of women who underwent cervical conization at a university teaching hospital from February 1996 to December 2001. Three modalities were used for conization: CO2 laser, large loop excision of the transformation zone and needle excision of the transformation zone. Negative cones were defined as those not showing evidence of human papillomavirus infection, intraepithelial neoplasia of squamous or glandular origin, or invasive disease.


RESULTS
During the study period, 817 conizations were performed. Of these, 206 (25%) were negative. Less than half the patients (41.7%) had a punch biopsy that matched the subsequent cone biopsy specimen. The negative cone rate in women with a punch biopsy showing cervical intraepithelial neoplasia (CIN) 1 was 60% in contrast with those who had a biopsy indicating CIN 2-3; the latter percentage was 16.5%, and the difference was statistically significant.


CONCLUSIONS
Close adherence to international guidelines during workup of an abnormal smear, meticulous colposcopy performed by a certified colposcopist and careful evaluation of punch biopsies by pathologists might help to decrease the negative cone rate.
Diakomanolis
Emmanuel
E
Colposcopy Unit 1st Department of Obstetrics and Gynecology, University of Athens, Pathology Department, Alexandra Hospital, Athens, Greece. gyninst@ath.forthnet.gr
Haidopoulos
Dimitrios
D
Chatzipapas
Ioannis
I
Rodolakis
Alexandros
A
Stefanidis
Konstantinos
K
Markaki
Sonia
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000473:pathology*; D003127:Colposcopy; D019092:Conization; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000473:pathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology*