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Biopsy Site Selection During Colposcopy and Distribution of Cervical Intraepithelial Neoplasia

Allard, Jay E. MD1; Rodriguez, Mildred MD1; Rocca, Mitra MS2; Parker, Mary F. MD2

Journal of Lower Genital Tract Disease: January 2005 - Volume 9 - Issue 1 - p 36-39
Original Articles

Objective. To determine if sites selected for colposcopic biopsy and histologically proven cervical intraepithelial neoplasia are distributed randomly across the cervix.

Materials and Methods. Data were evaluated from all patients who visited the Walter Reed Army Medical Center Colposcopy Clinic during a 20-month period. χ2 analysis was performed to assess the randomness of distribution of biopsies and cervical intraepithelial neoplasia.

Results. In 303 patients, 479 biopsies were performed. The 11-, 12-, and 1-o'clock positions were selected for 190 of 479 (40%) of biopsies, whereas the 6- and 12-o'clock positions were chosen for 186 of 479 (39%) of biopsies (p < 0.0001). Of 479 specimens, 161 (34%) were diagnosed as low-grade and 57 (12%) were diagnosed as high-grade. The 6-, 11-, and 12-o'clock positions accounted for 32 of 57 (56%) high-grade biopsies (p < 0.0001). The 6- and 12-o'clock positions accounted for 61 of 161 (38%) low-grade biopsies (p < 0.0001).

Conclusions. Loci selected for biopsy and histologically confirmed cervical intraepithelial neoplasia are not randomly distributed across the cervix. There is a predilection for the locations anterior and posterior to the cervical os.

Colposcopic biopsy site selection and distribution of histologically confirmed cervical intraepithelial neoplasia are not random, with a predilection for locations anterior and posterior to the cervical os.

1Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Walter Reed Army Medical Center and the National Naval Medical Center, Washington, DC; 2Telemedicine and Advanced Technology Research Center, US Army Medical Research and Materiel Command, Ft Detrick, MD

This research was funded and approved by the Department of Clinical Investigation (DCI) at Walter Reed Army Medical Center. The opinions or assertions contained herein are the private views of the Authors and are not to be construed as official or as reflecting the views of the Department of the Army, the Department of the Navy, or the Department of Defense. Reprint requests to: Mildred Rodriguez, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Room 6762, Building 2, 6900 Georgia Avenue, Washington, DC 20307-5001. E-mail:

©2005The American Society for Colposcopy and Cervical Pathology