Regardless of skill, performing more biopsies increases the sensitivity of colposcopy. Pretorius RG, Belinson JL, Burchette RJ, Hu S, Zhang X, Qiao YL. J Low Genit Tract Dis. 2011 Jul;15(3):180-8.
Performing more cervical biopsies and endocervical curettage routinely, even if the biopsies are randomly chosen (normal appearing tissue on colposcopy improves the detection of CIN 3+.
Number of cervical biopsies and sensitivity of colposcopy Gage JC, Hanson VW, Abbey K, Dippery S, Gardner S, Kubota J, Schiffman M, Solomon D, Jeronimo J; ASCUS LSIL Triage Study (ALTS) Group. Obstet Gynecol. 2006 Aug;108(2):264-72.
Regardless of medical training or background, conventional colposcopic biopsy practice only detects 66.7% of high grade (CIN 3+) dysplasia. The sensitivity improves when 2 or more biopsies are performed during colposcopy.
Utility of Random Cervical Biopsy and Endocervical Curettage in a Low-Risk Population. Pretorius RG, Belinson JL, Azizi F, Peterson PC, Belinson S. J Low Genit Tract Dis. 2012 May 22.
Approximately 21% of CIN 3+ was detected when random biopsies were performed in addition to customary directed biopsy during colposcopy.
Colposcopy to evaluate abnormal cervical cytology in 2008. Chase DM, Kalouyan M, DiSaia PJ.Am J Obstet Gynecol. 2009 May;200(5):472-80. Review.
Liberal use of biopsy in colposcopy and optical technologies that enhance the visualization of lesions during colposcopy will improve the detection of cervical cancer precursors.
Validity of sampling error as a cause of noncorrelation. Hearp ML, Locante AM, Ben-Rubin M, Dietrich R, David O. Cancer. 2007 Oct 25;111(5):275-9.
Approximately half of all biopsy proven high grade CIN is missed during colposcopy biopsy, when excisional LEEP or cone biopsy specimens are used for comparison. The authors conclude biopsy sampling error, due to mis-targeting or other factors are responsible.
A single random biopsy in the ATHENA tiral in patients with negative colposocpy (no lesions visualized), especially when the patient was HPV 16 or HPV 18 positive significantly increased the detection of CIN 2 or higher grade abnormalities. This post-hoc analysis of a population of 47,000 women undergoing cytology and HPV genotyping recommends the random biopsy practice in women who had no lesions visualized at colposcopy.
Excellent review on this article and also Wentsensen N, Walker JL, Gold MA, et al. Multiple biopsies and detection of cervical cancer precursors at colposcopy [published online ahead of print November 24, 2014]. J Clin Oncol. pii:JCO.2014.55.9948. at
Multiple biopsies and detection of cervical cancer precursors at colposcopy.
Diagnostic accuracy of guided cervical biopsies: a prospective multicenter study comparing the histopathology of simultaneous biopsy and cone specimen.
In a large prospective multicenter trail, usual cervical biopsy practice under-estimated the severity of neoplastic grade of lesions on the cervix in patients who subsequently underwent cone/excisional biopsy procedures. There were 4888 biopsies performed in 244 cases where the colposcopic punch biopsy-evidence workup underestrimate the highest grade dypslasia in 46.7% of cases.