title: Optimizing biopsy procedures during colposcopy for women with abnormal cervical cancer screening results: a multicenter prospective study.
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.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, 305-8575, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Koji
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Toyomi
authors.initials: T
authors.lastname: Satoh
authors.forename: Ken
authors.initials: K
authors.lastname: Nishide
authors.forename: Akiko
authors.initials: A
authors.lastname: Nozue
authors.forename: Koji
authors.initials: K
authors.lastname: Shimabukuro
authors.forename: Seiichi
authors.initials: S
authors.lastname: Endo
authors.forename: Kimihiro
authors.initials: K
authors.lastname: Nagai
authors.forename: Akinori
authors.initials: A
authors.lastname: Oki
authors.forename: Takeo
authors.initials: T
authors.lastname: Minaguchi
authors.forename: Yukio
authors.initials: Y
authors.lastname: Morishita
authors.forename: Masayuki
authors.initials: M
authors.lastname: Noguchi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshikawa
mesh_terms: D000328:Adult; D001706:Biopsy; D002584:Cervix Uteri / Q000473:pathology*; D003127:Colposcopy / Q000379:methods*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D002578:Uterine Cervical Dysplasia / Q000473:pathology*; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D055815:Young Adult