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Utility of Random Cervical Biopsy and Endocervical Curettage in a Low-Risk Population

Pretorius, Robert G. MD1; Belinson, Jerome L. MD2; Azizi, Faramarz MD3; Peterson, Patricia C.1; Belinson, Suzanne PhD2

Journal of Lower Genital Tract Disease: October 2012 - Volume 16 - Issue 4 - p 333–338
doi: 10.1097/LGT.0b013e3182480c18
Original Articles

Objective: The study aimed to determine the increase in the yield of cervical intraepithelial neoplasia 3 (CIN 3) or cancer (CIN 3+) from random cervical biopsy in quadrants without visible lesions and endocervical curettage (ECC) in a low-prevalence setting.

Materials and Methods: Random biopsy and ECC (unless pregnant) have been obtained in the colposcopy clinic of the Southern California Permanente Medical Group (SCPMG)-Fontana since 2004. We reviewed the colposcopy experience of SCPMG-Fontana for January 1, 2007, to December 31, 2009, to determine the method of diagnosis of CIN 3+.

Results: Between January 1, 2007, and December 31, 2009, 4677 women with median age 32 years had 4932 colposcopies in the SCPMG-Fontana colposcopy clinics. Cervical intraepithelial neoplasia 3+ was diagnosed in 295 women. Cervical biopsy detected 64.4% of CIN 3+; ECC diagnosed 5.1%; loop electrocautery excision procedure (LEEP) or cervical conization for cervical biopsy and/or ECC of CIN 2 diagnosed 27.8%; LEEP for the cytology of high-grade squamous intraepithelial lesion with cervical biopsy result of negative or CIN 1 diagnosed 1.4%; and LEEP, cervical conization, or biopsy in follow-up of CIN 2 diagnosed 1.4%. Sixty-one of the 295 cases of CIN 3+ (20.7%) were diagnosed after evaluation of random cervical biopsy and/or ECC of CIN 2+.

Conclusions: Random biopsy in cervical quadrants without visible lesions and ECC increased the yield of CIN 3+ in this low-risk colposcopy setting. Endocervical curettage can be omitted in women younger than 25 years.

Random biopsy and endocervical curettage increase the yield of cervical intraepithelial neoplasia 3 and cancer in a low-risk colposcopy setting.

1Department of Obstetrics and Gynecology, Southern California Permanente Medical Group-Fontana, Fontana, CA; 2Preventive Oncology International, Cleveland, OH; and 3Department of Pathology, Southern California Permanente Medical Group-Fontana, Fontana, CA

Reprint requests to: Robert G. Pretorius, MD, Department of Obstetrics and Gynecology, Southern California Permanente Medical Group-Fontana, 9961 Sierra Avenue, Fontana, CA 92335. E-mail: Robert.G.Pretorius@kp.org

The authors have no conflicts of interest to declare.

©2012The American Society for Colposcopy and Cervical Pathology