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Key Determinants of the Value of Random Cervical Biopsy at Colposcopy

Pretorius, Robert G. MD1; Belinson, Jerome L. MD2; Burchette, Raoul J. MS3; Wu, Ruifang MD4; Qiao, You-Lin MD, PhD5

Journal of Lower Genital Tract Disease: October 2019 - Volume 23 - Issue 4 - p 241–247
doi: 10.1097/LGT.0000000000000485
Original Research Articles: Cervix and HPV
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Objective The aim of the study was to assess whether lower proportions of cervical intraepithelial neoplasia 2+ diagnosed by random biopsy are from lower cut points defining an abnormal colposcopic impression or obtaining only one random biopsy when colposcopic impression is normal.

Methods We compared colposcopy experiences within Shanxi Province Cervical Cancer Screening Study (SPOCCS) (n = 1,383) and Shenzhen Cervical Cancer Screening Trial (SHENCCAST) (n = 631), which had instructive differences in the cut point defining an abnormal colposcopic impression.

Results The proportion of CIN 2+ diagnosed by random biopsy in SPOCCS (35.0%, 141/403) was higher than SHENCCAST (18.4%, 35/190, p < .001). Quadrant-specific receiver operating characteristic curves for diagnosis of CIN 2+ by colposcopic impression in SPOCCS and SHENCCAST were similar; a lower cut point for an abnormal colposcopic impression in SHENCCAST resulted in lower proportion of CIN 2+ diagnosed by random biopsy. Normal colposcopic impression was found in 85.1% (120/141) of cases of CIN 2+ diagnosed by random biopsy in SPOCCS and in 57.1% (20/35) of such cases in SHENCCAST. Of CIN 2+ diagnosed by random cervical biopsy with normal colposcopic impression, one cervical quadrant was involved with CIN 2+ in 66.7% (80/120) of colposcopies in SPOCCS and 80% (16/20) of colposcopies in SHENCCAST.

Conclusions Colposcopy series with higher proportions of CIN 2+ diagnosed by random biopsy likely have more stringent cut points defining an abnormal colposcopic impression and have more random biopsies when the colposcopic impression is normal. At colposcopy, we advise multiple biopsies of all acetowhite epithelium or multiple random biopsies to increase the sensitivity of colposcopy.

1Department of Obstetrics and Gynecology, Southern California Permanente Medical Group-Fontana, Fontana, CA

2Medworks, Cleveland, OH

3Department of Research and Evaluation, Southern California Permanente Medical Group-Los Robles, Los Robles, CA

4Department of OB/GYN, Peking University Shenzhen Hospital, Shenzhen, China and the Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, China

5Department of Epidemiology, Cancer Institute/Hospital, Chinese Academy Medical Sciences, Beijing, China

Reprint requests to: Robert G. Pretorius, MD, Dept. Ob/Gyn, SCPMG-Fontana, 9961 Sierra Ave, Fontana, CA 92335. E-mail: Robert.G.Pretorius@kp.org

The authors have declared they have no conflicts of interest.

Copyright © 2019 by the American Society for Colposcopy and Cervical Pathology