The use of colposcopic punch biopsy in the management of abnormal cervical cytology: a 5-year retrospective audit

• Published in: Journal of obstetrics and gynaecology Vol. 39; no. 1; p. 110
• Main Authors: Kahramanoglu, Ilker, Demirkiran, Fuat, Turan, Hasan, Bese, Tugan, Yilmaz, Nevin, Ilvan, Sennur, Arvas, Macit
• Format: Journal Article
• Language: English
• Published: England 02.01.2019
• Subjects: Adult; Biopsy - methods; Cervical Intraepithelial Neoplasia - diagnosis; Cervical Intraepithelial Neoplasia - surgery; Cervix Uteri - cytology; Colposcopy - methods; Electrosurgery; Female; Humans; Predictive Value of Tests; Retrospective Studies; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - surgery; cytology; cervical intraepithelial lesion; Colposcopy; conisation; LEEP; cervical biopsy
• ISSN: 1364-6893
• DOI: 10.1080/01443615.2018.1468740

The aim of this study was to determine the accuracy of colposcopic punch biopsy to detect cervical epithelial neoplasia (CIN) II + in patients with abnormal cervical cytology and the major colposcopic findings in patients who underwent a loop electrosurgical excision procedure (LEEP), subsequently. A total of 231 patients with abnormal cervical cytology who underwent a colposcopy guided cervical biopsy and subsequent LEEP were analysed. The mean age was 33.4 ± 8.7 years. CIN II + rate on LEEP pathology was significantly higher in patients with high-grade cytology, compared to those with a low-grade cytology (92 vs. 55%, p < .0001). CIN II + was found in 80, 98 and 100% of colpocopic biopsies of patients with LSIL, HSIL and AGC, respectively. The overall concordance rate between a colposcopic biopsy and LEEP was 41% with a kappa coefficient. The overall underestimation of CIN II + was 10.5%. On a patient-based analysis, the sensitivity, specificity, PPV and NPV of colposcopic biopsy were 89.4, 47.1, 79.5 and 66%, respectively. More than two cervical biopsies had 100% sensitivity for CIN II + on LEEP pathology. The specificity and PPV decreased with increasing number of cervical biopsies. A see-and-treat strategy may be considered for high-grade cytologies. Patients with a low-grade cytology should be managed with more than two colposcopic biopsies.