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Invasive Cancer Following Outpatient Evaluation and Therapy for Cervical Disease

From the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, and the University of Southern California School of Medicine, Los Angeles, California; and the Division of Obstetrical and Gynecological Pathology and Cytology, The Sloane Hospital for Women, Columbia-Presbyterian Medical Center, New York, New York

Abstract

Factors relating to the inappropriate therapy of 66 cases of cervical cancer are reviewed. The patients are divided into 3 major categories: 1) 33 who underwent cryosurgery or hot cautery without colposcopy; 2) 9 who underwent colposcopy without outpatient therapy; and 3) 24 who underwent colposcopy followed by outpatient therapy. Of the patients who had outpatient therapy without colposcopy, the major indication for treatment was "cervicitis," and all had a normal Papanicolaou smear. Of the 33 patients who underwent colposcopy because of an abnormal Papanicolaou smear, the proper treatment evaluation was carried out in only 5. The endocervical curettage (ECC) was omitted in 17 patients; no biopsies were taken in 8 patients; and conization of the cervix was omitted in 3 patients who had a positive ECC. Recommendations are made to minimize the inappropriate use of the outpatient approach in patients with cervical disease.