title: [Value of 4-quadrant biopsies under colposcopy for detecting precancerous lesions in cervical cancer screening].
abstract: OBJECTIVE
  To evaluate the value of colposcopical 4-quadrant biopsies for detecting precancerous lesion in cervical cancer screening.
  
  
  METHODS
  We used the data of a cross-sectional screening study in 1999, in which 1,997 women received cervical cancer screening in Xiang Yuan County, Shanxi province. The sensitivity, specificity and accuracy of both 4-quadrant biopsy and colposcopy directed biopsy to detect high-grade or more severe squamous intraepithelial lesions (HSIL+) were calculated.
  
  
  RESULTS
  1,784(89.3%) women who received 4-quadrant biopsies and endocervical curettage were negative. 127(6.4%) women were diagnosed as LSIL, 74(3.7%) women as HSIL and 12(0.6%) cases of squamous cell carcinoma. 1,478(74.0%) women who received biopsies in the sites of abnormal lesions were negative, 463(23.2%) cases of LSIL, 41(2.1%) cases of HSIL, 15(0.8%) cases of squamous cell carcinoma. The positive rate was 26.0%(519/1,997) for colposcopy, and the coincidence rate was 73.7% with pathological diagnosis. Sensitivity and specificity were 81.4% and 76.5% of colposcopy for HSIL+. In total of 519 women were found to be with any abnormal colposcopic appearance. The consistency rate between 4-quadrant biopsies and suspicious lesion-directed biopsies was 96.3%. By suspicious lesion-directed biopsy alone, 14.8% cervical lesions were miss-diagnosed, of which 8.6%(5/58) cases of total HSIL and 24.1%(14/58) cases of all LSIL.
  
  
  CONCLUSIONS
  4-quadrant biopsy can detect more HSIL+ lesions and is more accurate than suspicious lesion biopsy alone. As an important triage technique to detect cervical precancerous lesions, it can improve the detection rate of HSIL+ lesions in cervical cancer screening.
authors.affiliation: Department of Cancer Epidemiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: Yuqian
authors.initials: Y
authors.lastname: Zhao
authors.forename: Yan
authors.initials: Y
authors.lastname: Song
authors.forename: Fanghui
authors.initials: F
authors.lastname: Zhao
authors.forename: Wenhua
authors.initials: W
authors.lastname: Zhang
authors.forename: Ling
authors.initials: L
authors.lastname: Li
authors.forename: Feng
authors.initials: F
authors.lastname: Chen
authors.forename: Wen
authors.initials: W
authors.lastname: Chen
authors.forename: Qinjing
authors.initials: Q
authors.lastname: Pan
authors.forename: Guihua
authors.initials: G
authors.lastname: Shen
authors.affiliation: Email: qiaoy@cicams.ac.cn.
authors.forename: Youlin
authors.initials: Y
authors.lastname: Qiao
mesh_terms: D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D002584:Cervix Uteri / Q000473:pathology*; D003127:Colposcopy; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007044:Hysterectomy; D011230:Precancerous Conditions / Q000473:pathology*; D011247:Pregnancy; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000473:pathology*