title: Colposcopy and additive diagnostic value of biopsies from colposcopy-negative areas to detect cervical dysplasia.
abstract: BACKGROUND
  We evaluated colposcopy in the routine diagnostic workup of women with abnormal cervical cytology, as well as the diagnostic value of endocervical curettage material and biopsies taken from colposcopy-positive and colposcopy-negative quadrants of the cervix.
  
  
  METHODS
  This cross-sectional study included 297 nonpregnant women with abnormal cervical cytology and no prior treatment for cervical dysplasia or cancer. All women underwent gynecological examination, colposcopy, endocervical curettage, and had cervical biopsies taken. Colposcopy was considered satisfactory if the squamocolumnar junction was fully visible, and biopsies were taken from all four quadrants of the cervix, regardless of colposcopy results.
  
  
  RESULTS
  In all, 130 of the women in our study had satisfactory colposcopy results and were diagnosed with cervical intraepithelial neoplasia grade 2 or worse (CIN2+), 61% via a colposcopy-positive biopsy and 39% via a colposcopy-negative biopsy. Eighty-seven of them had positive colposcopy results, but CIN2+ was histologically verified from colposcopy-positive biopsies in 91% (n = 79) and from colposcopy-negative biopsies in 9% (n = 8). The remaining 43 women with CIN2+ had negative colposcopy findings, so their diagnosis was verified in colposcopy-negative biopsies. The sensitivity of colposcopy alone to detect CIN2+ was 61% (95% CI 52-69).
  
  
  CONCLUSIONS
  In the present study, colposcopy was not a stand-alone diagnostic method. Colposcopy-negative biopsies had a clear additive value, identifying a substantial proportion of women with both positive and negative colposcopy results with treatment-worthy cervical dysplasia. Endocervical curettage material had little diagnostic value in this study.
authors: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway. ingrid.baasland@ntnu.no.
authors: Ingrid
authors: http://orcid.org/0000-0003-0688-8031
authors: I
authors: Baasland
authors: Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.|Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
authors: Bjørn
authors: http://orcid.org/0000-0002-9904-3195
authors: B
authors: Hagen
authors: Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.|Department of Pathology and Medical Genetics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
authors: Christina
authors: http://orcid.org/0000-0001-6100-0539
authors: C
authors: Vogt
authors: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.|Department of Pathology and Medical Genetics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
authors: Marit
authors: http://orcid.org/0000-0001-7336-8779
authors: M
authors: Valla
authors: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
authors: Pål R
authors: http://orcid.org/0000-0003-2061-4336
authors: PR
authors: Romundstad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D002584:Cervix Uteri / Q000000981:diagnostic imaging / Q000473:pathology*; D003127:Colposcopy; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D002578:Uterine Cervical Dysplasia / Q000000981:diagnostic imaging / Q000473:pathology*; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D055815:Young Adult
keywords: Additional biopsy; cervical intra-epithelial neoplasia; colposcopy; colposcopy-negative biopsies; colposcopy-positive biopsies; endocervical curettage