Plate 180

Cervical conization is indicated for suspicious lesions of the uterine cervix to confirm or exclude the diagnosis of cervical cancer. Certain outpatient procedures usually precede conization and are useful in the investigation of cervical lesions. The Papanicolaou smear taken with an Ayerst applicator is an efficient method of establishing the diagnosis of gross or microscopic lesions of the uterine cervix. In the event of a suspicious Papanicolaou smear or an obvious lesion of the cervix, the cervix is sprayed with Graham's 7% iodine solution. A punch biopsy is taken in the area, which does not stain in an otherwise deep-mahogany stained cervix (Figure 1). After exposure of the cervix, the punch biopsy forceps is introduced, and a piece of unstained cervical tissue is removed with inclusion of a small bite of surrounding healthy tissue. Alternatively, many surgeons now stain the cervix with acetic acid and perform the biopsies with a culposcope.

A suspicious or positive Papanicolaou smear and/or positive punch biopsy necessitates operation with cold knife conization, the definitive diagnostic procedure for malignant lesions of the cervix.

(See Gynecologic System—Routine for Vaginal Procedures.) Douches are omitted.

Either general or spinal anesthesia is given.

The patient is placed in a dorsal lithotomy position.

The usual preparation of the perineum is carried out, but preparation of the vagina and cervix is avoided, lest loosely attached epithelium essential for diagnosis be destroyed. Even during the pelvic examination under anesthesia, the examiner's gloved fingers avoid the surface of the cervix. Following the pelvic examination, a speculum is inserted into the vagina and the anterior lip of the cervix is grasped with a single-toothed tenaculum. Dilatation and curettage is not performed before conization because it interferes with the lining ...