An audit to establish the proportion of cervical punch biopsies that meet criteria for adequacy

Abstract

This audit was carried out to develop the criteria recommended in various guidelines to establish if a punch biopsy of the cervix is adequate, and to determine if these are met in sufficient proportions of patients. A total of 100 patients who had cervical punch biopsies followed by large loop excision of the transformation zone (LLETZ) specimens were audited and the percentage of punch biopsies that met criteria for adequacy, cited in the criteria or developed from them, was established. Most of the biopsies met the criteria for adequacy, the exception being the presence of an intact squamo-columnar junction (SCJ), which was present in 14%. The highest grade of squamous intraepithelial lesion (SIL) on punch biopsy and LLETZ were most likely to differ if the SCJ was traumatised or not represented, or if the original biopsy were negative or showed ungradable SIL. These results suggest that most of these cervical biopsies originated in the optimal anatomical site on the cervix but were being damaged in an excessive number of cases and that this affected the reliability of the punch biopsy to predict the highest grade of SIL on LLETZ.

Keywords:

• Cervix
• dysplasia
• specimen adequacy

Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.