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

Abstract

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.

Impact statement

• What is already known on this subject? The improper management of women with CIN can increase the risk for cervical cancer. The ability of the colposcopic punch biopsy to detect the severity of a cervical abnormality has been called into question as false negative rates of up to 50% being reported.

• What do the results of this study add? The overall underestimation of CIN II + was found to be 10.5%. More than two cervical biopsies had 100% sensitivity for CIN II + on LEEP pathology.

• What are the implications of these findings for clinical practice and/or further research? The see-and-treat strategy is an appropriate choice for patients with a high-grade cytology. Patients with a low-grade cytology should be managed with more than two colposcopic biopsies.

Keywords:

• Colposcopy
• conisation
• cytology
• LEEP
• cervical biopsy
• cervical intraepithelial lesion

Disclosure statement

No potential conflict of interest was reported by the authors.