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The apparent area of the abnormal transformation zone (TZ) of the cervix was measured in a total of 104 patients by a simple method with the use of the 1 and 5 mm. diameter circle in the center of the field of the Leisegang colposcope and the field of the colposcope itself. The visible area (mean +/- S.E.M.) of the abnormal TZ for five patients with microinvasive or occult carcinoma of the cervix (180.8 mm.2 +/- 62.2) was significantly larger (p less than 0.01) than that of 64 patients with major intraepithelial lesions (62.5 sq. mm.2 +/- 7.3) and 35 patients with minor intraepithelial lesions (45.8 sq. mm.2 +/- 11.7). The visible area of the abnormal TZ measured over 40 mm.2 in each of the five patients with invasive lesions but in only 42 of 99 (42%) patients with intraepithelial lesions. The TZ extended into the endocervical canal and could not be fully visualized in four (80%) of the patients with invasive lesions, 24 (38%) of patients with major intraepithelial lesions, and 11 (31%) of patients with minor intraepithelial lesions. The implications of these findings are discussed.

A total of 259 patients underwent endocervical curettage as an integral part of colposcopic examination of patients with abnormal cervical cytology. The transformation zone was entirely visualized in 140 patients (54.1 per cent), and, in 8.6 per cent of this group, the endocervical curettings were abnormal. On no occasion did the endocervical curettage harbor the worst lesion when compared to the histology of the ectocervical biopsy, cone biopsy, and hysterectomy specimens. In 117 patients (45.2 per cent), the transformation zone could not be visualized in its entirety, and in 57.3 per cent the endocervical curettings were abnormal. In one patient of this group invasive carcinoma was present in the endocervical curettage, and in another patient invasive carcinoma was present in both the ectocervical biopsy and the endocervical curettage. Thus, when the entire transformation zone is not visualized in its entirety or at all, endocervical curettage appears to be of value since a frank invasive carcinoma may be diagnosed and a cone biopsy avoided.