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

Abstract

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 increased detection of cervical intraepithelial neoplasia when using a second biopsy at colposcopy

“…Studies have shown that conventional biopsy protocols miss up to 30% of prostate cancers, which has led to recommendations of extended biopsy procedures [22]. In other studies on cervical biopsies, multiple non-directed biopsies were collected and it was estimated that 10-30% of CIN2 + were found by these nondirected biopsies [5,7,8,23]. In our study, the total additional benefit of non-directed biopsies for detecting CIN2 + was 25/182 (13.7%; Table 3).…”

“…In a study investigating women with atypical cells of undetermined significance (ASC-US) cytology and CIN3 or invasive cervical cancer (ICC), it was found that gains in detecting cervical precancer can be obtained by increasing the number of lesion-directed biopsies from one to two [6]. Moreover, in studies that include biopsies of regions without colposcopic abnormality in addition to lesion-directed biopsies, 12 to 37% of the overall CIN2+ lesions were detected in this biopsy only [5,7,8].…”

Triage strategies in cervical cancer detection in Mexico: methods of the FRIDA Study

“…These studies report an improvement in detection of CIN2+ with increased by biopsy collection can be increased by as much as 37%. 18,[37][38][39] The involvement of colposcopists in the systematic collection of biopsies will be an important step to ensure the detection of CIN2 + cases that require prompt treatment. The FRIDA Study will also document the benefit of adopting a systematic collection of cervical biopsies as routine colposcopy practice.…”

Contribution of Exocervical Biopsy, Endocervical Curettage, and Colposcopic Grading in Diagnosing High-Grade Cervical Intraepithelial Neoplasia

“…17,18 Given the high prevalence of positive ECCs in our population of women who ultimately underwent therapy, the marginal utility of performing an ECC in cases where an excisional specimen validated the highest grade of dysplasia shows it contributed significantly to the discovery of CIN 2+ in that cohort, even among satisfactory colposcopies. This high correlation of ECC practice toward finding CIN 2+ resulting from thorough colposcopic biopsy practice and ultimate excision should not be confused with its use prospectively and the likelihood of an ECC contributing exclusively to the diagnosis of CIN 2+ in all patients referred to colposcopy (regardless of treatment status), which is lower.…”