National survey of the quality of 2nd level in screening for cervical cancer.

We collected, from the local registration systems of Italian organised cervical screening programmes, aggregated data (a) on the correlation between colposcopic grading and histology in routine colposcopies and (b) on treatment performed for screen-detected biopsy-proven cervical intraepithelial lesions (CIN). We obtained data on colpo-histological correlation from 40 programmes, reporting on 12,901 colposcopies, classified according to the 1990 international classification. Among them 37% were classified as normal and 25% as unsatisfactory (transformation zone not entirely visible). CIN1 or more severe histology was detected in 2273/4140 (65%) colposcopies classified as grade 1. CIN2 or more severe histology was detected in 566/853 (66.4%) colposcopies classified as grade 2. Of all women with CIN2 or more severe histology 42% had a colposcopy classified as grade 2 or higher. We obtained data on treatment from 57 programmes. Of the 2123 CIN1 cases 63% had follow-up only. However 20 (0.9%) had cold-knife conisation, 2 (0.1%) had hysterectomy and 191 (9.0%) were treated by diathermo-coagulation. Of the 1600 women with diagnosis of CIN2 or CIN3 4.2% had not been treated when data were collected and no data were available for another 8.2%. Electrosurgical excision was the most common treatment in these women (79% of those with known treatment). Some 0.7% of all CIN2 and 5.1% of all CIN3 had hysterectomy. Some 12% of the 111 invasive carcinoma, plausibly microinvasive, had excisional treatment only.