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The Use of the Colposcopically Directed Punch Biopsy in Clinical Practice: A Survey of British Society of Colposcopy and Cervical Pathology (BSCCP)-Accredited Colposcopists

Myriokefalitaki, Eva MD; Redman, Charles W.E. MD, FRCOG; Potdar, Neelam PhD; Pearmain, Philippa MSc; Moss, Esther L. PhD

Journal of Lower Genital Tract Disease: July 2016 - Volume 20 - Issue 3 - p 234–238
doi: 10.1097/LGT.0000000000000222
Original Research Articles: Cervix and HPV

Objectives The colposcopically directed punch biopsy has been an integral component of colposcopic practice. In light of the changing landscape of the cervical screening programme, a study was conducted to investigate the current practice of British Society of Colposcopy and Cervical Pathology–accredited colposcopists on technique and rationale for performing a punch biopsy.

Materials and Methods A web-based questionnaire survey was e-mailed to all British Society of Colposcopy and Cervical Pathology–accredited colposcopists. Questions included selection criteria for performing a punch biopsy, number of biopsies, and technique. Results were analyzed by specialty, experience, and workload.

Results A total of 749 colposcopists responded, 50.2% of the 1,493 total. The respondents were obstetrician and gynecologists (42.9%), gynecologists/oncologists (33.6%), and nurse colposcopists (19.8%). Most colposcopists (78.3%) had more than 5-year colposcopy experience and saw in excess of 11 new cases (73.4%) of abnormal cervical cytology/month. Most colposcopists (56%) aimed to take 2 biopsies to diagnose cervical intraepithelial neoplasia, and very few (16.2%) reported routinely taking random biopsies from normal areas of cervix. Looking at the trends in management in the case scenarios, there was a lower threshold for performing punch biopsy before large loop excision of the transformation zone in younger (age, <25 years) or nulliparous women versus older women (age, >40 years; p < .05). Colposcopists were more likely to take biopsies in women with low-grade cytology/colposcopic findings (71.2%, always or most of the times) as compared with high-grade cytology/colposcopic findings (40.3%, never or rarely).

Conclusions Colposcopically directed punch biopsy is routinely used by colposcopists; however, techniques, number of biopsies taken, and rationale for performing a biopsy vary greatly between colposcopists.

A survey investigates the differences in clinical practice and use of the colposcopically directed punch biopsy. Supplemental digital content is available in the text.

1Department of Gynecology, University Hospitals of Leicester, Leicester; 2Department of Gynecology, University Hospital of North Midlands, Staffordshire; 3West Midlands Cancer Screening QA Reference Center Public Health England, London; and 4Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, UK.

Correspondence to: Esther Moss, Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester Royal Infirmary, Leicester, UK, LE2 7LX, E-mail:

The authors have declared they have no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Copyright © 2016 by the American Society for Colposcopy and Cervical Pathology