Can colposcopy replace conization?

The reintroduction of colposcopy and the introduction of outpatient therapy have significantly altered the management of the woman with an abnormal Pap smear. Routine conization is no longer considered mandatory, particularly for the lower grades of CIN. We estimate that over 10,000 gynecologists in North America have received instruction in colposcopy. Virtually every teaching hospital and medical center has colposcopy available. It is a valuable evaluative tool, particularly with the increasing risk of CIN in young women and the fact that more women are delaying childbearing until the third and fourth decades of life. The technique does, however, require a rigorous period of training, significant experience, and strict adherence to an established evaluation protocol. In the hands of the neophyte, the consequences of in-appropriate evaluation of the woman with an abnormal Pap smear can be tragic.