Skip Navigation LinksHome > October 2012 - Volume 16 - Issue 4 > Is the Colposcopically Directed Punch Biopsy a Reliable Diag...
Journal of Lower Genital Tract Disease:
doi: 10.1097/LGT.0b013e318250acf3
Original Articles

Is the Colposcopically Directed Punch Biopsy a Reliable Diagnostic Test in Women With Minor Cytological Lesions?

Moss, Esther L. PhD1; Hadden, Paula1; Douce, Gill FRCPath2; Jones, Peter W. PhD3; Arbyn, Marc MD, DrTMH4; Redman, Charles W.E. MD1

Collapse Box

Abstract

Objective: The study aimed to determine the accuracy of the colposcopy-directed punch biopsy (punch) to detect or exclude high-grade cervical intraepithelial neoplasia (CIN 2 or 3) in women with atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL) cytological result and minor colposcopic findings.

Materials and Methods: In a diagnostic test accuracy study, women with ASCUS or LSIL cytological result and minor colposcopic changes had a single colposcopy-targeted punch biopsy was performed immediately followed by a loop electrocautery excision procedure (LEEP) biopsy. The trial was powered to detect a level of κ for a dichotomous outcome of 0.4 (i.e., fair-to-moderate agreement), with a two-sided significance level of 5% and a power of 90%. Accuracy parameters were computed using a cutoff for positive punch biopsy result of CIN 1+ and CIN 2+ for an outcome of CIN 2+ and CIN 3+ assessed in the LEEP specimen.

Results: Sixty-eight punch biopsy/LEEP–paired samples were analyzed. Of the 8 CIN 3 lesions, 6 and 4 were detected at cutoff CIN 1+ and CIN 2+, respectively (sensitivity, 50% and 75%). The corresponding specificities were 65% (39/60) and 97% (58/60). The punch biopsies identified only 14 (67%) or 6 (20%) of the 21 CIN 2+ lesions at cutoff CIN 1+ or CIN 2+, respectively. Of the punch biopsies, 31 (45.6%) accurately detected the severity of cervical abnormality.

Conclusions: A single colposcopically directed punch biopsy appears to be insufficient to exclude underlying CIN 2 or 3.

©2012The American Society for Colposcopy and Cervical Pathology

Login

Article Tools

Share

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.