Regardless of Skill, Performing More Biopsies Increases the ... : Journal of Lower Genital Tract Disease (original) (raw)

ORIGINAL ARTICLES

Regardless of Skill, Performing More Biopsies Increases the Sensitivity of Colposcopy

Pretorius, Robert G. MD1; Belinson, Jerome L. MD2; Burchette, Raoul J. MS3; Hu, Shangying MD4; Zhang, Xun MD4; Qiao, You-Lin MD, PhD4

1Department of Obstetrics and Gynecology, Southern California Permanente Medical Group-Fontana, Fontana, CA; 2Department of Gynecology, The Cleveland Clinic Foundation, Cleveland, OH; 3Department of Research and Evaluation, Southern California Permanente Medical Group, Los Robles, CA; and 4Department of Epidemiology, Cancer Institute/Hospital, Chinese Academy Medical Sciences, Beijing, China

Correspondence to: Robert G. Pretorius, MD, Department of Obstetrics and Gynecology, Southern California Permanente Medical Group-Fontana, 9961 Sierra Ave, Fontana, CA 92335. E-mail: [email protected]

Correspondence to: You-Lin Qiao, MD, PhD, Cancer Institute/Hospital, Chinese Academy of Medical Sciences, 17 S. Panjiayuan LN, Beijing 100021 China. E-mail: [email protected]

Supported by Preventive Oncology International, Inc, Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Beijing, China, and the Taussig Cancer Center of The Cleveland Clinic Foundation.

Objectives.

The objectives of this study were to compare the sensitivity of colposcopically directed biopsy (biopsy of cervical quadrants with colposcopic impressions of human papillomavirus, cervical intraepithelial neoplasia [CIN], or cancer) for CIN 3 or cancer (CIN 3+) among physicians and to estimate the increase in yield of CIN 3+ per colposcopy associated with "random" biopsies and/or endocervical curettage (ECC).

Methods.

Two studies in which 7 physicians performed 1,383 colposcopic examinations on women with abnormal cervical cytology were reviewed. At colposcopy, the cervix was divided into quadrants by lines from the 12- to the 6-o'clock and from the 3- to the 9-o'clock positions. Each quadrant was assigned a colposcopic impression of normal, human papillomavirus or CIN 1, CIN 2 or CIN 3, or cancer. Each quadrant had biopsy of colposcopically detected lesions or "random" biopsy at the squamocolumnar junction if the colposcopic impression was normal. Lastly, ECC was obtained.

Results.

Among the physicians, the sensitivity of colposcopically directed biopsy for CIN 3+ varied from 28.6% to 92.9% (p < .001). With logistic regression, the sensitivity of colposcopically directed biopsy for CIN 3+ increased as the number of cervical quadrants with CIN 3+ increased (p < .001); once corrected for the number of quadrants with CIN 3+, differences between the physician's sensitivities remained significant (p = .01). For 6 of 7 physicians, the yield of CIN 3+ per colposcopy was greater when colposcopically directed biopsy was augmented by up to 4 "random" biopsies plus ECC (p = .03 to p < .001).

Conclusions.

The sensitivity of colposcopy for CIN 3+ varies widely. Performing up to 4 "random" biopsies plus ECC increases the yield of CIN 3+.