Colposcopically directed cone biopsies in the management of cervical intraepithelial neoplasia.

Thirty-three patients with severe dysplasia and carcinoma in situ had a colposcopically directed cone biopsy in the operating room immediately prior to vaginal hysterectomy. In 3 cases (9%), the hysterectomy specimen showed the same type of residual disease as in the cone biopsy; in the remainder no residual disease was evident in the hysterectomy specimen. If colposcopically directed biopsies were performed, the long-term debate over the use of cone biopsy or hysterectomy for intraepithelial neoplasms would be resolved. Selected patients could be treated adequately by cone biopsy with a small number of patients requiring hysterectomy as indicated by direct examination with the colposcope.