Colposcopic Cervical Biopsies: More Is Usually Better

Andrew M. Kaunitz, MD


February 19, 2015

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Hello. I'm Andrew Kaunitz, professor and associate chair in the ob/gyn department, University of Florida College of Medicine, in Jacksonville, Florida. Today I'd like to discuss colposcopic cervical biopsies: Often, more is better.

Many clinicians take only one ectocervical biopsy at the time of colposcopy. Recent reports provide good-quality data to guide us regarding the number of biopsies we should perform to best detect high-grade cervical pathology requiring treatment.

One report published in late 2014[1] focused on the value of a single, random cervical biopsy when colposcopy was performed for abnormal cytology, high-risk HPV, or both, but did not reveal cervical lesions. Among almost 2800 such women, biopsy was normal in 90%, revealed CIN1 in 6%, and CIN2 or worse in 3%.

In a second report published in January 2015,[2] investigators studied almost 700 women referred for colposcopy. Up to four biopsies of acetowhite lesions were performed. Sensitivity for detecting CIN2 or worse increased from 61% with one biopsy to 86% with two biopsies, and to 96% with three biopsies.

Failure to detect high-grade cervical lesions can delay treatment, lead to repeat colposcopies, and place patients at risk for invasive cancer. These two recent reports are consistent with a 2006 study[3] which found that, regardless of a clinician's experience, taking two or more colposcopic biopsies enhances diagnostic yield.

In my practice, when I see no colposcopic lesions, I perform at least one random biopsy. When I do see lesions, I usually obtain at least two to three ectocervical biopsies.

Thank you. Please leave your comments below.


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