Value of multi-quadrants biopsy: Pooled analysis of 11 population-based cervical cancer screening studies

Abstract

Objective The accuracy of colposcopy-guided biopsy is key to the success of colposcopic triage in cervical cancer screening programs. However, there is no widely adopted biopsy guideline up to date. Our study aimed to determine whether multi-quadrants biopsy improves the yield of cervical lesions. Methods Eleven population-based cervical cancer screening studies were conducted in China. Cytology, high-risk human papillomavirus (hrHPV) testing and visual inspection were performed for primary screening. Females positive on one or more tests were referred for colposcopy and biopsy. The proportion of detected cervical intraepithelial neoplasia (CIN)2+ and yields by quadrant lesion-targeted biopsy or 4-quadrant random biopsy were compared. Results Among 4,923 females included, 1,606 had quadrant lesion-targeted biopsy, and 3,317 had 4-quadrant random biopsy. The cumulative CIN2+ yield increased from 0.10 for only one quadrant-targeted biopsy to 0.21, 0.34, and 0.58 for at most two, three and four quadrants targeted biopsies. Among hrHPV positive females with high-grade squamous intraepithelial lesion (HSIL)+ cytology, the cumulative CIN2+ yield of a second targeted biopsy in another quadrant was significantly increased (P<0.05). Among hrHPV-negative females, the yield of 4-quadrant random biopsies was 0.005, and the yield by lesion-targeted biopsies was 0.017. For hrHPV positive females who had 4-quadrant random biopsy, the additional CIN2+ yield for HSIL+, low-grade squamous intraepithelial lesion (LSIL) cytology, or abnormal visual inspection via acetic acid and Lugol’s iodine (VIA/VILI) were 0.46, 0.11, 0.14. Conclusions A 4-quadrant random biopsy is recommended only for hrHPV positive females with HSIL cytology, and is acceptable if hrHPV positive with LSIL cytology or with abnormal VIA/VILI. Our findings add evidences for an objective and practical biopsy standard to guide colposcopy in cervical cancer screening programs in low- and middle-income countries.

Evaluation of colposcopy after the addition of human papillomavirus testing to the Turkish cervical cancer screening program

“…Many studies suggest that multiple biopsies may be beneficial even when colposcopic evaluation reveals no abnormality. 22 , 23 , 24 According to a study by Pretorius et al. 24 performing multiple biopsies increased sensitivity regardless of experience.…”

“…According to that punch biopsy should be obtained from the worst one among the lesions such as thin aceto‐white epithelium, fine punctation, or dense aceto‐white epithelium. Many studies suggest that multiple biopsies may be beneficial even when colposcopic evaluation reveals no abnormality 22–24 . According to a study by Pretorius et al 24 .…”

“…Many studies suggest that multiple biopsies may be beneficial even when colposcopic evaluation reveals no abnormality. [22][23][24] According to a study by Pretorius et al 24 performing multiple biopsies increased sensitivity regardless of experience. However, EFC did not include the average number of punches or the percentage of punch biopsies among their quality standards.…”

The Performance of Artificial Intelligence in Cervical Colposcopy: A Retrospective Data Analysis

“…However, in real-world clinical practice, the countries and areas that suffered from the heavy disease burden of cervical cancer were usually at a shortage of experienced colposcopists. To improve the sensitivity of colposcopyguided biopsy, some suggested taking a multibiopsy and random biopsy from the normal appearing quadrants [27][28][29]. However, a widely adopted biopsy guideline is absent hitherto.…”

Effectiveness of high-risk human papillomavirus genotyping for cervical cancer screening. A multicentre screening cohort study in rural China

“…However, its incidence in developing countries has not been effectively reduced due to the lack of standardisation and insufficient coverage 6 . Although close to 80 million women have been screened in China's rural areas in the past decade, this represents less than 30% of the female population in this country 7 , far from the screening target of 70% proposed by the WHO.…”