The abnormal Pap smear--what to do next?

The patient with an abnormal Papanicolaou smear must have proper and adequate diagnostic evaluation to determine the degree of cervical abnormality. Gross clinical evaluation alone is inadequate for definitive diagnosis because cytologic screening identifies patients with preclinical disease. Outpatient diagnostic evaluation must include colposcopy, colposcopic-directed biopsies, endocervical curettage, and pelvic examination. Conization of the cervix is required whenever these techniques are unsatisfactory or are unable to rule out invasive cancer. When outpatient diagnostic procedures including cytologic analysis rule out invasive disease, one may elect cryosurgery, electrocautery, or laser in treating cervical intraepithelial neoplasia. Nevertheless, conization or hysterectomy may be inpatient treatments for selected patients.