Does mild atypia on a cervical smear warrant further investigation?

228 women referred to a colposcopy clinic over a 10-year period with mildly atypical cervical cytology had a histological diagnosis established by colposcopically directed biopsy. Of the 187 women (82.0%) who had dyskaryosis on the referral smear, 129 (69%) had cervical intraepithelial neoplasia (CIN) grade II or III on histology, as did 12 (29.2%) of the 41 women without dyskaryosis. 27.6% of smears taken at the time of colposcopy had normal cytology, although a third of these women had CIN II or III diagnosed on histology at that time. The poor correlation between mildly atypical cervical cytology and histology suggests that the practice of relying on cytology alone for the surveillance of women who have already had an atypical smear should be discouraged.