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July 15, 1992

Obstetrics and Gynecology

Author Affiliations

The Johns Hopkins University School of Medicine, Baltimore, Md; Northwestern University Medical School, Chicago, Ill

JAMA. 1992;268(3):384-385. doi:10.1001/jama.1992.03490030096043

In keeping with the American fascination for using high-tech medical procedures, treatment of early cervical neoplasia typically follows the sequence of (1) Papanicolaou test, (2) colposcopy, (3) biopsy, and, finally, (4) laser therapy. The use of colposcopy and colposcopy-directed biopsy as a diagnostic approach to cervical intraepithelial neoplasia (CIN) has eliminated the need for most cold-knife conizations of the cervix. The elimination of conizations has led to a significant decrease in hospitalization costs, a decrease in immediate operative morbidity, and elimination of potential harmful long-term effects of cervical stenosis on fertility. The majority of patients with CIN are women of reproductive age, and conservative management of these lesions is mandatory.

Once a diagnosis of CIN is made, if the perimeters of the lesion can be visualized, most gynecologists will proceed with laser ablation of the cervix. Colposcopy-directed biopsies alone may fail to detect a significant number of lesions, including microinvasive