Evaluation of the simultaneous use of cytology and biopsy in the diagnosis of carcinoma of the cervix

Abstract It has been a standard practice to use both cytological smears and biopsy to obtain a positive diagnosis in suspected cases of carcinoma of the cervix uteri. However, the usual practice is to use one or the other alone during the initial examination, resorting to the one not already used to obtain corroborative evidence. Believing that prompter and more definitive diagnoses might be obtained by using both methods at the first examination, we undertook a study of 500 new patients admitted to the Cook County Out-Patient Gynecological Clinic, with a view to ascertaining the accuracy of the diagnoses of cervical carcinoma by an initial routine of combined use of cytology smear and biopsy. Previously one of us (M. W. R.) had made a study of some 6,000 cytological smears, † †To be reported later. most of which had been taken as a "screening" prior to biopsy; during this study, discrepancies were noted. In some instances, the cytology was apparently in error, while in others, the error appeared in the biopsy. However, in some of these, when the biopsy was repeated, it was found to be in agreement with the earlier cytology. These observations suggested the present study, especially in view of the fact that, in some of these cases, the final result was the diagnosis of a carcinoma which was clinically unsuspected. We had abundant precedents for the use of both methods, since many earlier workers have concluded that these types of studies are valuable diagnostic aids in the detection of carcinoma of the uterus, especially of the cervix. Lock and Caldwell 9 performed 1,797 biopsy examinations on cervices that deviated from the normal, finding 9.2 per cent indicative of cervical carcinoma. Beclere 2 obtained closely similar results; 790 clinic patients yielded 9.4 per cent positive readings. Whichever their preference, all workers agree that a cytological diagnosis of carcinoma should be confirmed by biopsy, with the final diagnostic criterion being the histological diagnosis.