title: The Use of the Colposcopically Directed Punch Biopsy in Clinical Practice: A Survey of British Society of Colposcopy and Cervical Pathology (BSCCP)-Accredited Colposcopists.
abstract: OBJECTIVE
  The colposcopically directed punch biopsy has been an integral component of colposcopic practice. In light of the changing landscape of the cervical screening programme, a study was conducted to investigate the current practice of British Society of Colposcopy and Cervical Pathology-accredited colposcopists on technique and rationale for performing a punch biopsy.
  
  
  METHODS
  A web-based questionnaire survey was e-mailed to all British Society of Colposcopy and Cervical Pathology-accredited colposcopists. Questions included selection criteria for performing a punch biopsy, number of biopsies, and technique. Results were analyzed by specialty, experience, and workload.
  
  
  RESULTS
  A total of 749 colposcopists responded, 50.2% of the 1,493 total. The respondents were obstetrician and gynecologists (42.9%), gynecologists/oncologists (33.6%), and nurse colposcopists (19.8%). Most colposcopists (78.3%) had more than 5-year colposcopy experience and saw in excess of 11 new cases (73.4%) of abnormal cervical cytology/month. Most colposcopists (56%) aimed to take 2 biopsies to diagnose cervical intraepithelial neoplasia, and very few (16.2%) reported routinely taking random biopsies from normal areas of cervix. Looking at the trends in management in the case scenarios, there was a lower threshold for performing punch biopsy before large loop excision of the transformation zone in younger (age, <25 years) or nulliparous women versus older women (age, >40 years; p < .05). Colposcopists were more likely to take biopsies in women with low-grade cytology/colposcopic findings (71.2%, always or most of the times) as compared with high-grade cytology/colposcopic findings (40.3%, never or rarely).
  
  
  CONCLUSIONS
  Colposcopically directed punch biopsy is routinely used by colposcopists; however, techniques, number of biopsies taken, and rationale for performing a biopsy vary greatly between colposcopists.
authors.affiliation: 1Department of Gynecology, University Hospitals of Leicester, Leicester; 2Department of Gynecology, University Hospital of North Midlands, Staffordshire; 3West Midlands Cancer Screening QA Reference Center Public Health England, London; and 4Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, UK.
authors.forename: Eva
authors.initials: E
authors.lastname: Myriokefalitaki
authors.forename: Charles W E
authors.initials: CW
authors.lastname: Redman
authors.forename: Neelam
authors.initials: N
authors.lastname: Potdar
authors.forename: Philippa
authors.initials: P
authors.lastname: Pearmain
authors.forename: Esther L
authors.initials: EL
authors.lastname: Moss
mesh_terms: D000328:Adult; D001706:Biopsy / Q000379:methods*; D003127:Colposcopy; D003955:Diagnostic Tests, Routine / Q000379:methods*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D013048:Specimen Handling / Q000379:methods*; D011795:Surveys and Questionnaires; D006113:United Kingdom; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D055815:Young Adult