Comparison of repeat smear, colposcopy, and colposcopically directed biopsy in the evaluation of the mildly abnormal smear.

Repeat smear, colposcopy, and colposcopically directed biopsy were performed in 161 patients referred to our department because of a Pap smear showing mild dysplasia (CIN 1). Colposcopically directed biopsies revealed the presence of CIN of different grades in 61 cases (37.5%). In 33 (20.4%) the CIN grade found at biopsy was higher than 1. Repeat smear confirmed the presence of CIN 1 in 67 women (47.2%). In this group of patients colposcopically directed biopsies showed a CIN grade greater than 1 in 12 cases (17.9%). The repeat smear was negative in 59 patients (41.5%). In this group, biopsy showed varying grades of neoplasia in 12 cases. Colposcopic examination indicated no dysplasia but the presence of minor cervical abnormalities in 76 women (47.2%): at biopsy a CIN grade higher than 1 was found in 9 cases (11.5%). These data suggest that the mildly atypical smear identifies a group of patients at increased risk of CIN but gives little or no information on the disease severity. Repeat smear and colposcopic examination alone appear inadequate to demonstrate the severity of the cervical lesion. Due to the high proportion of CIN 2 and 3 in patients with a mildly abnormal smear, the systematic biopsy of any colposcopically abnormal area seems essential to proper management of the patient.