Institutional members access full text with Ovid®

Share this article on:

Random Biopsy After Colposcopy-Directed Biopsy Improves the Diagnosis of Cervical Intraepithelial Neoplasia Grade 2 or Worse

Nam, Kyehyun MD, PhD1; Chung, Sooho MD1; Kwak, Jeongja MD2; Cha, Sangheon MD1; Kim, Jeongsik MD1; Jeon, Seob MD1; Bae, Donghan MD, PhD1

Journal of Lower Genital Tract Disease: October 2010 - Volume 14 - Issue 4 - p 346-351
doi: 10.1097/LGT.0b013e3181e9635b
Original Articles

Objectives. To evaluate the usefulness of additional random biopsies in the diagnosis of cervical intraepithelial neoplasia grade 2 (CIN 2) or worse (CIN 2+) after colposcopy-directed biopsy.

Materials and Methods. A retrospective chart review was performed in 107 women with satisfactory colposcopy results after colposcopy-directed biopsy with random biopsy for abnormal cervical cytological evaluation at Soonchunhyang University Hospital between April 2008 and November 2009. Random biopsies were performed at the cervical squamocolumnar junction in lesion-free quadrants of the cervix. Loop electrosurgical excision procedure conizations were performed in 59 women. Age, referral cytology, lesion size, human papilloma virus (HPV) viral load, and HPV type were analyzed as possible indicators of lesion severity detected using random biopsy.

Results. The mean age was 39.3 years (range = 21-72 y), and 96 (89.7%) women were premenopausal. Sixty-three women had CIN 2+; of those, 8 (12.7%) were diagnosed using random biopsies: 6 had high-grade squamous intraepithelial lesions; 1 had low-grade squamous intraepithelial lesions; and 1 had atypical squamous cells of undetermined significance. Lesions diagnosed as CIN 2+ using random biopsies were significantly correlated with high-grade cytology (p <.001) and lesion size (p <.001) but not age (cutoff = 40 years), HPV viral load (cutoff = 300 relative light units; Hybrid Capture 2), or HPV genotype. Of 59 patients who underwent loop electrosurgical excision procedure conization, the disease severity of 9 (15.3%) cases was upgraded 1 or more grades, compared with the punch biopsy results.

Conclusions. The detection of CIN 2+, particularly high-grade cytological abnormalities and large lesion size, can be increased by additional random biopsies after satisfactory colposcopy. Loop electrosurgical excision procedure conization can detect lesions not detected by punch biopsy.

The random biopsy should be considered as an additional procedure for managing cervical cytological abnormality by colposcopy.

1Division of Gynecologic Oncology, Departments of Obstetrics & Gynecology and 2Pathology, Soonchunhyang University Hospital, Bucheon-Si, Gyunggi-Do, Republic of Korea

Correspondence to: Kyehyun Nam, MD, PhD, Department of Obstetrics & Gynecology, Soonchunhyang University Hospital, # 1174, Jung-dong, Wonmi-ku, Gyunggi-do, Republic of Korea, 420-767. E-mail:

©2010The American Society for Colposcopy and Cervical Pathology