Colposcopically directed punch biopsy: a potentially misleading investigation

Abstract

Objective— To determine the relation between the histology of an initial colposcopically directed punch biopsy and a subsequent diathermy loop excision biopsy of the transformation zone, and the effect of lesion size on this relation. Design— Prospective observational study of loop diathermy excision biopsies of the cervical transformation zone. Setting— Academic unit colposcopy clinics at The Birmingham and Midland Hospital for Women and Dudley Road Hospital, Birmingham. Subjects— 243 women managed by colposcopy and directed punch biopsy followed by loop diathermy excision. Outcome measures— The histology of the punch biopsy and the excised transformation zone and the size of the abnormal lesion. Results— In 132 (54%) of the 243 women the histology of the punch biopsy and loop excision specimen did not agree. In 62 (47%) of these 132 women a more severe lesion was found in the excised transformation zone, including three unsuspected adenocarcinoma in situ and one stage Ia1 cancer. In 39 (41%) of the 96 women in whom a lesion of CIN 3, or greater severity, was found in the loop excision specimen, the paired punch biopsy had suggested a lesion of lesser severity. In small area lesions, the punch biopsy was more likely to show more severe disease than the loop excision specimen (P= 0.0014). Conclusions— The results suggest that directed punch biopsy is an inadequate endpoint by which to judge the severity of an epithelial lesion. The findings have important implications for patient management and the design of trials and cast doubt on the results of studies using punch biopsy as an endpoint.

Identification of cervical intraepithelial neoplasia (CIN) using UV‐excited fluorescence and diffuse‐reflectance tissue spectroscopy

“…Unfortunately, colposcopy shares some of the shortcomings of the Pap smear. Because it is a qualitative assessment of the cervix, its accuracy is dependent on the training and experience of the physician [3]. Several studies have reported that colposcopically directed cervical punch biopsies have a false negative rate ranging from 15 to 31%.…”

Validity of Colposcopy in the Diagnosis of Early Cervical Neoplasia: A Review

“…Fundamental to such a management strategy is the assumption that the colposcopist can identify accurately the area of most severe epithelial abnormality from which to take a punch biopsy. 16 Colposcopic assessment is thus a critical stage in the diagnosis of early cervical neoplasia, as the detection of abnormal cervical cytology is dependent on precise visual localisation of micropathological changes and precise biopsy of such tissue for subsequent histopathologic diagnosis. Colposcopy thus plays a crucial role in the diagnosis of early cervical disease, with management decisions often anchored on the colposcopic assessment.…”

Carcinoma Microinvasor no Cone Pós Biópsia Dirigida Compatível com NIC 3

“…Ehsani et al 12 , após avaliarem mulheres submetidas à CAF por citologia compatível com NIC 2 e 3 e resultado de biópsia sugestivo de NIC 1, encontraram lesão de alto grau em 41% dos cones, indicando o resultado falso-negativo da biópsia. Buxton et al 13 , avaliando 243 mulheres submetidas à conização e com citologias com alterações celulares graves, encontraram discordância em 54%, e com lesão mais grave no cone, em 47% dos casos, incluindo três adenocarcinomas in situ e um caso de câncer invasor.…”