Six hundred ninety-seven women with abnormal cervical smears were detected through a screening program in Allegheny County, Pa. Two hundred ninety-one were biopsied by means of 270 conizations and 81 punch biopsies. Further tissue diagnoses were necessary, as evidenced by both histologic and cytologic findings, after 7.0% of the conizations and 54.1% of the punch biopsies. Among the 39 women in whom cone biopsy followed punch biopsy, the diagnoses on cone were more serious in 48.7%, the same in 33.3% and less serious in 17.9%. Punch biopsy was not found to be an alternative to conization in making a final diagnosis, unless that diagnosis was invasive cancer. Rather, punch biopsy was an adjunct to cytology in determining the need for conization.