Abnormal Pap smears: A comparison of total abdominal hysterectomy and cone biopsy in management

Summary

A recent study found that colposcopy is still not available to over 50% of gynaecologists practicing in Nigeria and that 91% of them will do either cone biopsy or hysterectomy for moderately or severely abnormal Pap smears. Currently, there are no local data to guide such patient care. In order to compare cone biopsy and hysterectomy in terms of their pick-up rates of cervical intraepithelial neoplasia and invasive cancer in women with abnormal pap smears, a retrospective review of entries in the histology reports of all cases of cone biopsy and hysterectomy done for abnormal Pap smears from 1975 – 2004 at the histopathology department of the University of Nigeria Teaching Hospital, Enugu, Nigeria, was carried out. The study revealed that 203 women with moderately to severely abnormal Pap smears were treated with either cone biopsy or hysterectomy. A total of 88 (43.3%) women had cone biopsy, while the remaining 115 (56.7%) had total abdominal hysterectomy. Those who had cone biopsy were significantly younger than those who had hysterectomy (mean ages: 44.6 ± 8.8 vs 52.3 ± 9.8 years; p = 0.008). There was no significant difference in parity between those who had cone biopsy and those who had hysterectomy (mean parity: 5.7 ± 2.3 vs 6.5 ± 2.2; p = 0.102). For all the 203 women, the histology was reported as normal in 97 (47.8%) women and inflammatory in six (3.0%). The three cases of invasive cervical carcinoma were found in women with moderately abnormal Pap smears. One had a cone biopsy, while the other two had a simple total abdominal hysterectomy. Cone biopsy and hysterectomy did not differ significantly in their pick-up rates of the various categories of cervical lesions including invasive carcinoma (p > 0.05 for all categories). It was concluded that cone biopsy and hysterectomy have similar pick up rates for the various types of cervical lesions. For this reason, in the absence of colposcopy as occurs in many parts of the developing world, cone biopsy may be adequate treatment and should be offered first to women with moderately to severely abnormal Pap smears.