Random biopsy in colposcopy-negative quadrant is not effective in women with positive colposcopy in practice

Song, Yan; Zhao, Yuqian; Zhang, Xun; Liu, Xiaoyang; Li, Ling; Pan, Qin-Jing; Shen, Gui-Hua; Zhao, Fen; Chen, Feng; Chen, Wen; Qiao, You‐Lin

doi:10.1016/j.canep.2015.01.008

Cited by 11 publications

(7 citation statements)

References 14 publications

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“…However, women with cytological ASC-US/LSIL and positive HR-HPV, AGC, ASC-H or HSIL+ had a higher absolute risk of CIN2+ or CIN3+, and should be given more attention and receive 4-quadrant biopsies plus ECC. [31] These actions are in accord with the attention given to those with abnormal cytology in the recent guideline of American Society of Colposcopy & Cervical Pathology, which recommend that women with cytological negative but positive HR-HPV, or ASC-US/LSIL and negative HR-HPV, should be followed up. [32] Our findings also confirmed the necessity of ASC-US/LSIL triage with HR-HPV.…”

Section: Discussionmentioning

confidence: 92%

Pooled analysis on the necessity of random 4-quadrant cervical biopsies and endocervical curettage in women with positive screening but negative colposcopy

Hu¹,

Zhang²,

Li³

et al. 2017

Medicine

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Controversy remains over whether random cervical biopsies and endocervical curettage (ECC) should be used in women with positive screening but negative colposcopy. Our paper aims to determine the indications for random biopsies and ECC among these screened positive women.Three thousand two hundred thirteen women with any positive screening test result but negative colposcopy, who received random 4-quadrant biopsies, were pooled from 17 population-based cervical cancer screening studies done in China from 1999 to 2008. The detection rates of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and CIN grade 3 or worse (CIN3+) stratified by cytology and high-risk human papillomavirus (HR-HPV) status were assessed, as well as the false negative rates for CIN2+ and CIN3+ by random biopsies without ECC.Compared with women with negative cytology and positive HR-HPV, those with atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion (ASC-US/LSIL) and negative HR-HPV had the equivalent lower risks of CIN2+ and CIN3+, but ascending risks were observed in the groups of ASC-US/LSIL and positive HR-HPV, and atypical glandular cells/atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion/high-grade squamous intraepithelial lesion or worse (AGC/ASC-H/HSIL+). If random biopsies were only taken without ECC, 9.3% of CIN2+ and 18.5% of CIN3+ would have been missed.For women with any positive screening but negative colposcopy, in areas with good cytological infrastructure, it was necessary to perform random biopsies plus ECC on those with cytological ASC-US/LSIL and positive HR-HPV, AGC, ASC-H, or HSIL+. In contrast, those with other results should be followed up.

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Section: Discussionmentioning

confidence: 92%

Pooled analysis on the necessity of random 4-quadrant cervical biopsies and endocervical curettage in women with positive screening but negative colposcopy

Hu¹,

Zhang²,

Li³

et al. 2017

Medicine

Self Cite

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“…However, due to the lack of enough experienced clinicians and qualified histopathologists, the sampling and diagnose for biopsy and ECC remain obstacles to improving the quality of the program. It has been reported that random biopsy could increase the HSIL+ yield in women with high-grade cytology [ 4 , 5 ]. The current guideline [ 6 ] prefer endocervical sampling for non-pregnant women with LSIL cytology if the colposcopic examination is inadequate or no lesion is identified; and it is acceptable if the colposcopy is adequate and a lesion is present.…”

Section: Introductionmentioning

confidence: 99%

A retrospective analysis of the utility of endocervical curettage in screening population

Song

Zhao

et al. 2017

Oncotarget

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The performance of endocervical curettage (ECC) is a dispute in population screening programs. Data of 3,460 women referred to colposcopy examination and had completed pathological results in the Shanxi Province Cervical Cancer Screening Study I and II were reviewed. Among them, 0.6% and 2.7% women were identified as the histopathological confirmed high-grade squamous intraepithelial lesion or worse (HSIL+) by ECC alone or both ECC and quadrants biopsy respectively. Age, cytology, and colposcopy impression are the impact factors for the HSIL+ yield of ECC (P<0.05). The age-adjusted odds ratio for cytology and colposcopic impression were 5.283 (95%CI: 3.989-6.997) and 3.609 (95%CI: 2.910-4.476) respectively. In low-grade squamous intraepithelial lesion cytology and abnormal colposcopy, no additional HSIL+ was found by ECC. In low-grade squamous intraepithelial lesion cytology but normal colposcopy, the additional yield was 0.6%, 0.8% and 1.1% for the three age groups respectively. In high-grade squamous intraepithelial lesion or worse cytology, the additional HSIL+ yield by ECC ranged between 1.4% and 6.6%. We conclude that the performance of ECC increases with age, the severity of cytology, and colposcopic impression. For women 35 years and older, ECC should be performed if the cytological finding is high-grade or worse in cervical cancer screening program.

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“…However, not all women benefit from the ECC method in the same way and the debate about its effectiveness is still high ( 18 ). Colposcopists usually perform ECC according to the personal experience, rather than scientific evidence, which is likely to result in higher adverse events for patients ( 16 , 17 ).…”

Section: Discussionmentioning

confidence: 99%

The Effect of Random Biopsy and Endo-Cervical Curettage in Diagnosis of Precancerous Cervical Lesions in Women With Normal Colposcopy

Ghahghaei-Nezamabadi,

Tehranian,

Feizabad

et al. 2024

JFRH

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Objective: This study aimed to evaluate the effect of random biopsy and endo-cervical curettage (ECC), alone and together, in the diagnosis of high-grade cervical lesions in women with normal colposcopy. Materials and methods: This cross-sectional study was conducted on 356 women who underwent colposcopy examination in the gynecology-oncology clinic of Roointan-Arash Women’s Hospital, affiliated with Tehran University of Medical Sciences. All eligible women underwent colposcopy. In colposcopy examination, up to four biopsy samples were randomly taken for each quartile of the cervix and ECC was performed. Finally, the rate of intraepithelial neoplasia (CIN) and the relation between random biopsy and ECC and CIN diagnosis was determined. Results: In total, 27 (7.6%) low-grade squamous intraepithelial lesions (LSIL) and 19 (5.3%) high-grade squamous intraepithelial lesions (HSIL) were detected in cases that underwent random biopsy. There was a significant association between the abnormal random biopsy results and having multiple sexual partners (p=0.001), cigarette (p=0.041), and hookah (p=0.033) smoking. Furthermore, 31 (8.7%) LSIL and 42 (11.8%) HSIL were reported in women who underwent ECC. There was a significant relation between the abnormal results of ECC and hookah consumption (p=0.008) and human papillomavirus (HPV) infection (p=0.011). The concordance (p=0.001) between random biopsy and ECC result was 71.2% and only in 28.8% of the cases one of the methods was normal and the other was abnormal. Conclusion: The present study showed that the simultaneous use of ECC and random biopsy in women with normal colposcopy increases the detection rate of precancerous lesions by up to 28.8%.

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Random biopsy in colposcopy-negative quadrant is not effective in women with positive colposcopy in practice

Cited by 11 publications

References 14 publications

Pooled analysis on the necessity of random 4-quadrant cervical biopsies and endocervical curettage in women with positive screening but negative colposcopy

Pooled analysis on the necessity of random 4-quadrant cervical biopsies and endocervical curettage in women with positive screening but negative colposcopy

A retrospective analysis of the utility of endocervical curettage in screening population

The Effect of Random Biopsy and Endo-Cervical Curettage in Diagnosis of Precancerous Cervical Lesions in Women With Normal Colposcopy

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