Multiple biopsies improve cervical cancer detection in colposcopyBMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h55 (Published 08 January 2015) Cite this as: BMJ 2015;350:h55
Taking multiple biopsies during colposcopy improves detection of cervical cancer precursor lesions when compared with the current practice of taking only a single biopsy, a systematic US study has found.1
Women with abnormal cervical screening results are referred for further examination of the cervix by colposcopy. This typically involves a detailed examination after an acetic acid wash, which stains white any areas of cell change. The area with the most severe cell changes is then biopsied, and the biopsy is studied to decide whether to excise the surrounding tissue.
“Despite its importance in the management of cervical abnormalities, there has been no primary evaluation of colposcopy biopsy performance in the US,” said the study authors, led by Nicolas Wentzensen of the National Cancer Institute in Bethesda, Maryland, USA. They warned that previous secondary analyses had shown that colposcopic impression and biopsy placement failed to detect 30-50% of precancerous lesions.
Their observational study followed up 690 women referred for colposcopy after abnormal cervical screening results. Researchers took as many as four directed biopsies from areas of the cervix that had stained white with acetic acid wash. In addition, they took a non-directed biopsy of an area that appeared normal in women who had fewer than four acetowhite lesions.
Results showed that the sensitivity in detecting cervical cancer precursors (high grade squamous intraepithelial lesions) increased from 60.6% (95% confidence interval 54.8% to 66.6%) with a single biopsy, to 85.6% (80.3% to 90.2%) with two biopsies. Sensitivity increased further with three biopsies to 95.6% (91.3% to 99.2%).
The greatest increase in detection of high grade squamous intraepithelial lesions with more biopsies was in women with a high grade colposcopic impression, those with cytology indicating cervical cancer precursors, and those who tested positive for human papillomavirus type 16.
“Taking additional biopsies should become the standard practice in colposcopic biopsy for women with multiple lesions,” the researchers concluded.
Cite this as: BMJ 2015;350:h55