Optimizing biopsy procedures during colposcopy for women with abnormal cervical cancer screening results: a multicenter prospective study
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In cervical cancer screening programs, women with abnormal cytology results are referred to colposcopy for histological diagnosis. This study was designed to evaluate the sensitivity of colposcopic procedures for detecting cervical cancer and its precursor, cervical intraepithelial neoplasia (CIN).
Women referred to colposcopy for abnormal cytology were enrolled from four hospitals. Gynecologists were required to take a colposcopy-guided biopsy from the worst of the abnormal-looking areas as a first biopsy. They were also asked to take ≥3 cervical specimens including by endocervical curettage (ECC). Random biopsies were performed at the gynecologist’s discretion. We analyzed 827 biopsy results from 255 women who were diagnosed by central pathologists as having histology of CIN or cancer.
In this study, 78.1 % of diagnoses of CIN grade 2 or worse (CIN2+) (the threshold that would trigger intensive management) were obtained from a first colposcopy-guided biopsy. The additional diagnostic utility of second and third colposcopy-guided biopsies was 16.4 and 1.8 %, respectively. The combined sensitivity of two colposcopy-directed biopsies for CIN2+ detection was >90 %, regardless of the colposcopist. Random biopsies and ECC increased the diagnostic yield of CIN2+ lesions otherwise missed by colposcopy-guided biopsies alone, but only by 1.2 and 2.4 %, respectively. Random biopsies were more useful for women referred after low-grade abnormal cytology (P = 0.01). The utility of ECC was greatest among women with unsatisfactory colposcopy (P = 0.03) or aged ≥40 years (P = 0.02).
Our data suggest that at least two colposcopy-directed biopsies should be taken for histological diagnosis. Random biopsies and ECC are recommended for special populations.
KeywordsColposcopy Biopsy CIN Cervical cancer
The authors thank Chizuko Fukui and Yoko Kuno for technical assistance; Kokoro Hirai and Chieko Abe for assistance in data collection; many other researchers who facilitated this study; and all the women who participated in the study. This work was supported by grants from the Ministry of Education, Science, Sports and Culture of Japan (Grant # 25462585) and the Ibaraki Clinical and Epidemiological Cancer Research Project. The supporting organizations played no role in the design and implementation of the study; the collection, management, analysis and interpretation of the data; or the preparation, review or approval of the manuscript.
Conflict of interest
We declare that we have no conflicts of interest relevant to this article.
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