The role of random cervical biopsies in addition to colposcopy-directed biopsies in detection of CIN2+

Vallapapan, Atittaya; Chandeying, Nutthaporn; Srijaipracharoen, Sunamchok; Uthagethaworn, Khwanarnong

doi:10.1080/01443615.2018.1474186

Cited by 5 publications

(5 citation statements)

References 23 publications

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“…These observations have led to the practice of taking multiple targeted biopsies from colposcopic abnormal areas and taking random biopsies from normal looking areas to improve the detection rate of high-grade CIN. It has been shown that multiple quadrant lesion-directed biopsies during colposcopy increased detection of high-grade CIN ( 13 , 19 , 21 - 23 ) and our results are consistent with this observation. The incremental benefit of taking multiple quadrant biopsies in improving the diagnosis of high-grade CIN is clear in our study.…”

Section: Discussionsupporting

confidence: 92%

“…A Japanese study concluded that two targeted biopsies should be taken, and random biopsies at normal appearing quadrants are recommended for low-grade cytology ( 22 ). A study in Thailand concluded that multiple biopsies increased the sensitivity of CIN2+ detection ( 23 ). In our study, in addition to the first targeted biopsy, a second one could significantly improve the cumulative sensitivity of lesion-targeted biopsy by nearly 25%.…”

Section: Discussionmentioning

confidence: 99%

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Value of multi-quadrants biopsy: Pooled analysis of 11 population-based cervical cancer screening studies

Zhao

et al. 2020

Chinese Journal of Cancer Research

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Objective The accuracy of colposcopy-guided biopsy is key to the success of colposcopic triage in cervical cancer screening programs. However, there is no widely adopted biopsy guideline up to date. Our study aimed to determine whether multi-quadrants biopsy improves the yield of cervical lesions. Methods Eleven population-based cervical cancer screening studies were conducted in China. Cytology, high-risk human papillomavirus (hrHPV) testing and visual inspection were performed for primary screening. Females positive on one or more tests were referred for colposcopy and biopsy. The proportion of detected cervical intraepithelial neoplasia (CIN)2+ and yields by quadrant lesion-targeted biopsy or 4-quadrant random biopsy were compared. Results Among 4,923 females included, 1,606 had quadrant lesion-targeted biopsy, and 3,317 had 4-quadrant random biopsy. The cumulative CIN2+ yield increased from 0.10 for only one quadrant-targeted biopsy to 0.21, 0.34, and 0.58 for at most two, three and four quadrants targeted biopsies. Among hrHPV positive females with high-grade squamous intraepithelial lesion (HSIL)+ cytology, the cumulative CIN2+ yield of a second targeted biopsy in another quadrant was significantly increased (P<0.05). Among hrHPV-negative females, the yield of 4-quadrant random biopsies was 0.005, and the yield by lesion-targeted biopsies was 0.017. For hrHPV positive females who had 4-quadrant random biopsy, the additional CIN2+ yield for HSIL+, low-grade squamous intraepithelial lesion (LSIL) cytology, or abnormal visual inspection via acetic acid and Lugol’s iodine (VIA/VILI) were 0.46, 0.11, 0.14. Conclusions A 4-quadrant random biopsy is recommended only for hrHPV positive females with HSIL cytology, and is acceptable if hrHPV positive with LSIL cytology or with abnormal VIA/VILI. Our findings add evidences for an objective and practical biopsy standard to guide colposcopy in cervical cancer screening programs in low- and middle-income countries.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Value of multi-quadrants biopsy: Pooled analysis of 11 population-based cervical cancer screening studies

Zhao

et al. 2020

Chinese Journal of Cancer Research

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“…In Poland, the experts led by Professor R. Jach created the project named Meijer protocols [7]. Increasing the number of taken targeted sections and performing a random biopsy of the transformation zone in the case of higher screening irregularities significantly lifts sensitivity from 84% to 100% [14].…”

Section: Discussionmentioning

confidence: 99%

Histopathological discrepancies between colposcopy-directed biopsy and LEEP-conization observed during SARS-CoV-2 pandemic

Przybylski¹,

Zmaczyński²,

Jach³

et al. 2023

Ginekol Pol

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Objectives: Long-term exposure to the human papillomavirus (HPV) is a known cause of squamous intraepithelial lesions that lead to cervical cancer. The loop electrosurgical excision procedure (LEEP) conization is an established treatment method. According to the latest recommendations, we present a paper to evaluate the effectiveness of various diagnostic methods of squamous intraepithelial lesions. Material and methods: We analyzed 229 patients who reported to District Public Hospital in Poznan to undergo LEEP conization in 2019-2021 during the SARS-CoV-2 Pandemic. The analysis included Pap smear/liquid-based cytology, HPV genotyping, colposcopy with targeted biopsy and LEEP-conization. We offered post-treatment HPV vaccination and, as a follow-up, performed HPV re-genotyping after six months. Results: In total, 89.1% of patients were HPV-positive. The coloscopy-directed biopsy (CDB) results show that almost 70% of the patients had high-grade intraepithelial lesions (HSIL). The diagnosis obtained by LEEP-conization showed that half of the women were diagnosed with HSIL and one-third with the low-grade squamous intraepithelial lesion (LSIL). The sensitivity of Pap smear/LBC accounted for 93.7% and was lower than for CDB, which reached 95.1%. Both diagnostic methods tend to underestimate the final diagnosis. Conclusions:The inclusion of a colposcopic examination in an in-depth diagnostic process in women with abnormal Pap smear results facilitates the identification of patients requiring therapeutic intervention. LEEP-conization may be used without the primary biopsy. It applies to multiparous women in the perimenopausal period, extensive abnormalities, discrepancies in test results, extensive visible abnormalities, and suspicion of invasive cervical cancer in the colposcopic examination.

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“…In contrast, an American RCT only found 54% sensitivity in diagnosing CIN3 4 . Several other studies have also reported low sensitivity, and authors have suggested that biopsies also be taken from colposcopically normal areas 5–13 . Many studies suffer from verification bias, as the outcome depends on the biopsies from the very lesions identified by colposcopy.…”

Section: Introductionmentioning

confidence: 99%

“… 4 Several other studies have also reported low sensitivity, and authors have suggested that biopsies also be taken from colposcopically normal areas. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 Many studies suffer from verification bias, as the outcome depends on the biopsies from the very lesions identified by colposcopy. Moreover, histopathological analysis, the gold standard, has been found to have only moderate interobserver reproducibility.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of colposcopy in the Swedish screening program

Alfonzo

Zhang²,

Daneshpip

et al. 2023

Acta Obstet Gynecol Scand

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Introduction: Sensitivity and specificity of colposcopy vary greatly between studies and efficacy in clinical studies seldom corresponds with effectiveness in a real-life setting. It is unclear whether colposcopists' experience affects assessment; studies show divergent results. The study's objective was to investigate the accuracy of colposcopies in the Swedish screening program, the variability in colposcopists' assessments and whether degree of experience affects accuracy in a routine setting. Material and methods:Cross-sectional register study. All colposcopic assessments with a concomitant histopathological sample from women aged at least 18 years, performed between 1999 and September 2020 in Sweden. The main outcome measure was accuracy. The accuracy of colposcopic assessments was calculated as overall agreement with linked biopsies, with three outcomes: Normal vs Atypical, Normal vs Low-Grade Atypical vs High-Grade Atypical, and Non-High-Grade Atypical vs High-Grade Atypical. A time-trend analysis was performed. The accuracy of identifiable colposcopists related to experience was analyzed. Results:In total, 82 289 colposcopic assessments with linked biopsies were included for analysis of the outcome Normal vs Atypical; average accuracy was 63%. Overrating colposcopic findings was four times more common than underrating. No time trend in accuracy was noted during the study period. Accuracy in distinguishing High-Grade from Non-High-Grade lesions was better: 76%. Among identifiable colposcopists, overall accuracy was 67%. Some had significantly better accuracy than others, but no correlation with experience was found.Conclusions: Colposcopy, including in a referral setting, has low accuracy in distinguishing Normal from Atypical. Increased experience alone does not lead to improvement. This is supported by the substantial differences in performance between colposcopists.

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The role of random cervical biopsies in addition to colposcopy-directed biopsies in detection of CIN2+

Cited by 5 publications

References 23 publications

Value of multi-quadrants biopsy: Pooled analysis of 11 population-based cervical cancer screening studies

Value of multi-quadrants biopsy: Pooled analysis of 11 population-based cervical cancer screening studies

Histopathological discrepancies between colposcopy-directed biopsy and LEEP-conization observed during SARS-CoV-2 pandemic

Accuracy of colposcopy in the Swedish screening program

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