Cone biopsy in the older woman

Summary

The results of cone biopsies performed for cervical dyskaryosis in 50 postmenopausal women were compared with those in 50 premenopausal women. In 15 per cent of the 100 women, cone biopsy identified no pathology. A greater proportion of postmenopausal women had incomplete cone excision for all degrees of dyskaryosis, compared with premenopausal women (P < 0-05). For those patients with at least moderate dyskaryosis postmenopausal women appeared to be incompletely managed by cone biopsy. Forty-two per cent of the older women with severely dyskaryotic smears had incomplete cone excisions and proceeded to hysterectomy; of 19 premenopausal women referred with severe dyskaryosis only one had incomplete cone excision and was subjected to hysterectomy (P < 0-05). Invasive disease was commoner in the older women (P = 0-001) and occurred in patients from this group who had mild cytological abnormalities on referral. Six women in whom cone excision was complete had a simple hysterectomy subsequently. For postmenopausal women, the indication for hysterectomy in two was bleeding after cone biopsy and two had persisting abnormal smears; in the premonopausal women two had cervical stenosis and haematometra. Postmenopausal women with moderate dyskaryosis or worse are more likely than premonopausal women to require further surgery after cone biopsy.