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International Journal of Clinical Oncology

Published in:

01-06-2015 | Original Article

Optimizing biopsy procedures during colposcopy for women with abnormal cervical cancer screening results: a multicenter prospective study

Authors: Yuko Nakamura, Koji Matsumoto, Toyomi Satoh, Ken Nishide, Akiko Nozue, Koji Shimabukuro, Seiichi Endo, Kimihiro Nagai, Akinori Oki, Takeo Minaguchi, Yukio Morishita, Masayuki Noguchi, Hiroyuki Yoshikawa

Published in: International Journal of Clinical Oncology | Issue 3/2015

Abstract

Background

In cervical cancer screening programs, women with abnormal cytology results are referred to colposcopy for histological diagnosis. This study was designed to evaluate the sensitivity of colposcopic procedures for detecting cervical cancer and its precursor, cervical intraepithelial neoplasia (CIN).

Methods

Women referred to colposcopy for abnormal cytology were enrolled from four hospitals. Gynecologists were required to take a colposcopy-guided biopsy from the worst of the abnormal-looking areas as a first biopsy. They were also asked to take ≥3 cervical specimens including by endocervical curettage (ECC). Random biopsies were performed at the gynecologist’s discretion. We analyzed 827 biopsy results from 255 women who were diagnosed by central pathologists as having histology of CIN or cancer.

Results

In this study, 78.1 % of diagnoses of CIN grade 2 or worse (CIN2+) (the threshold that would trigger intensive management) were obtained from a first colposcopy-guided biopsy. The additional diagnostic utility of second and third colposcopy-guided biopsies was 16.4 and 1.8 %, respectively. The combined sensitivity of two colposcopy-directed biopsies for CIN2+ detection was >90 %, regardless of the colposcopist. Random biopsies and ECC increased the diagnostic yield of CIN2+ lesions otherwise missed by colposcopy-guided biopsies alone, but only by 1.2 and 2.4 %, respectively. Random biopsies were more useful for women referred after low-grade abnormal cytology (P = 0.01). The utility of ECC was greatest among women with unsatisfactory colposcopy (P = 0.03) or aged ≥40 years (P = 0.02).

Conclusions

Our data suggest that at least two colposcopy-directed biopsies should be taken for histological diagnosis. Random biopsies and ECC are recommended for special populations.

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Title: Optimizing biopsy procedures during colposcopy for women with abnormal cervical cancer screening results: a multicenter prospective study
Authors: Yuko Nakamura
Koji Matsumoto
Toyomi Satoh
Ken Nishide
Akiko Nozue
Koji Shimabukuro
Seiichi Endo
Kimihiro Nagai
Akinori Oki
Takeo Minaguchi
Yukio Morishita
Masayuki Noguchi
Hiroyuki Yoshikawa
Publication date: 01-06-2015
Publisher: Springer Japan
Published in: International Journal of Clinical Oncology / Issue 3/2015
Print ISSN: 1341-9625
Electronic ISSN: 1437-7772
DOI: https://doi.org/10.1007/s10147-014-0739-6

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Abstract

Background

Methods

Results

Conclusions

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