title: Random biopsy after colposcopy-directed biopsy improves the diagnosis of cervical intraepithelial neoplasia grade 2 or worse.
abstract: OBJECTIVE
  To evaluate the usefulness of additional random biopsies in the diagnosis of cervical intraepithelial neoplasia grade 2 (CIN 2) or worse (CIN 2+) after colposcopy-directed biopsy.
  
  
  METHODS
  A retrospective chart review was performed in 107 women with satisfactory colposcopy results after colposcopy-directed biopsy with random biopsy for abnormal cervical cytological evaluation at Soonchunhyang University Hospital between April 2008 and November 2009. Random biopsies were performed at the cervical squamocolumnar junction in lesion-free quadrants of the cervix. Loop electrosurgical excision procedure conizations were performed in 59 women. Age, referral cytology, lesion size, human papilloma virus (HPV) viral load, and HPV type were analyzed as possible indicators of lesion severity detected using random biopsy.
  
  
  RESULTS
  The mean age was 39.3 years (range = 21-72 y), and 96 (89.7%) women were premenopausal. Sixty-three women had CIN 2+; of those, 8 (12.7%) were diagnosed using random biopsies: 6 had high-grade squamous intraepithelial lesions; 1 had low-grade squamous intraepithelial lesions; and 1 had atypical squamous cells of undetermined significance. Lesions diagnosed as CIN 2+ using random biopsies were significantly correlated with high-grade cytology (p <.001) and lesion size (p <.001) but not age (cutoff = 40 years), HPV viral load (cutoff = 300 relative light units; Hybrid Capture 2), or HPV genotype. Of 59 patients who underwent loop electrosurgical excision procedure conization, the disease severity of 9 (15.3%) cases was upgraded 1 or more grades, compared with the punch biopsy results.
  
  
  CONCLUSIONS
  The detection of CIN 2+, particularly high-grade cytological abnormalities and large lesion size, can be increased by additional random biopsies after satisfactory colposcopy. Loop electrosurgical excision procedure conization can detect lesions not detected by punch biopsy.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Soonchunhyang University Hospital, Bucheon-Si, Gyunggi-Do, Republic of Korea. khnambc@yahoo.co.kr
authors.forename: Kyehyun
authors.initials: K
authors.lastname: Nam
authors.forename: Sooho
authors.initials: S
authors.lastname: Chung
authors.forename: Jeongja
authors.initials: J
authors.lastname: Kwak
authors.forename: Sangheon
authors.initials: S
authors.lastname: Cha
authors.forename: Jeongsik
authors.initials: J
authors.lastname: Kim
authors.forename: Seob
authors.initials: S
authors.lastname: Jeon
authors.forename: Donghan
authors.initials: D
authors.lastname: Bae
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods*; D002584:Cervix Uteri / Q000473:pathology; D003127:Colposcopy / Q000379:methods*; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification; D056910:Republic of Korea; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology