title: Number of cervical biopsies and sensitivity of colposcopy.
abstract: OBJECTIVE
  To examine the influence that type of medical training and number of biopsies have on sensitivity of colposcopically guided biopsies.
  
  
  METHODS
  Among 408 women with an adequate enrollment colposcopy and a diagnosis of cervical intraepithelial neoplasia (CIN) 3 or cancer (CIN 3+) over 2 years in the Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesions (ASCUS-LSIL) Triage Study, we evaluated factors influencing the sensitivity of the enrollment colposcopic procedure. We used contingency table analysis to examine confounding variables and chi(2) tests to ascertain statistical significance.
  
  
  RESULTS
  Overall, 69.9% of women with a cumulative diagnosis of CIN 3+ had a "true-positive" enrollment colposcopically guided biopsy result of CIN 2 or worse (CIN 2+), the threshold that would trigger excisional therapy. The sensitivity of the procedure did not vary significantly by type of colposcopist. However, the sensitivity was significantly greater when the colposcopists took two or more biopsies instead of one (P<.01), a pattern observed across all types of colposcopists. Independent of the severity of the colposcopic impression, the frequency with which colposcopists took two or more biopsies instead of one varied (in descending order) from nurse practitioners to general gynecologists to gynecologic oncology fellows to gynecologic oncologists (P<.01).
  
  
  CONCLUSIONS
  Colposcopy with guided biopsy or biopsies detects approximately two thirds of CIN 3+. Although the sensitivity of the procedure does not differ significantly by type of medical training, it is greater when two or more biopsies are taken.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA.
authors.forename: Julia C
authors.initials: JC
authors.lastname: Gage
authors.forename: Vivien W
authors.initials: VW
authors.lastname: Hanson
authors.forename: Kim
authors.initials: K
authors.lastname: Abbey
authors.forename: Susan
authors.initials: S
authors.lastname: Dippery
authors.forename: Susi
authors.initials: S
authors.lastname: Gardner
authors.forename: Janet
authors.initials: J
authors.lastname: Kubota
authors.forename: Mark
authors.initials: M
authors.lastname: Schiffman
authors.forename: Diane
authors.initials: D
authors.lastname: Solomon
authors.forename: Jose
authors.initials: J
authors.lastname: Jeronimo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002983:Clinical Competence; D003127:Colposcopy / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D002578:Uterine Cervical Dysplasia / Q000473:pathology*