Clinical Review
2014 Update on cervical disease
Integration of the HPV test into cervical screening adds complexity but clarifies optimal management in many cases
When performing colposcopy for abnormal cytology results or high-risk human papillomavirus (HPV), clinicians often are faced with an absence of visible lesions. This situation raises the following question in his or her mind: “Should I perform a random biopsy?”
Details of the study
In a multicenter US study of more than 47,000 women, performed to assess HPV diagnostics between May 2008 and August 2009, colposcopy was performed in nonpregnant women aged 25 or older with an intact uterus due to atypical squamous cells of undetermined significance or greater cytology results or high-risk HPV. The study participants and the colposcopists were blinded to the test results. In women with satisfactory colposcopy results but in whom no colposcopic lesions were noted, one random biopsy of the squamocolumnar junction was performed.
Among 2,796 women (mean age, 39.5 years) with a random biopsy performed, the findings were: normal, cervical intraepithelial neoplasia (CIN)−1, CIN2, and CIN3 in 90.0%, 5.7%, 1.3%, and 1.4%, respectively. Among all participants aged 25 and older, random biopsies accounted for 20.9% and 18.9% of the CIN2 or worse and CIN3 or worse cases, respectively. Among women positive for HPV 16 or 18, the likelihood of the random biopsy detecting CIN2 or worse was 24.7% and 8.6% for those with abnormal cytology or normal cytology, respectively.
What this evidence means for your practice
Consistent with other reports, the results of this post hoc analysis underscore the limitations of colposcopy. Just as results of a prior study indicated that taking two or more biopsies increases diagnostic yield,1 this large study points out the substantial benefit gained from performing a random biopsy of the squamocolumnar junction when no colposcopic lesions are identified.
—Andrew M. Kaunitz, MD
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