The Effect of Random Biopsy and Endo-Cervical Curettage in Diagnosis of Precancerous Cervical Lesions in Women With Normal Colposcopy
Abstract
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%.
1. Tehranian A, Ghahghaei-Nezamabadi A, Motiei Langeroudi M, Aghajani R. Comparison of Visual Inspection Methods Using Either Acetic Acid Solution or Lugol’s Iodine Solution with Colposcopy in Screening of Cervical Cancer: A Cross Sectional Study. Journal of Obstetrics, Gynecology and Cancer Research. 2023;8(1):53-6.
2. Smith HJ, Leath CA 3rd, Huh WK, Erickson BK. See-and-Treat for High-Grade Cytology: Do Young Women Have Different Rates of High-Grade Histology? J Low Genit Tract Dis. 2016;20(3):243-6.
3. Cantor SB, Cárdenas-Turanzas M, Cox DD, Atkinson EN, Nogueras-Gonzalez GM, Beck JR, et al. Accuracy of colposcopy in the diagnostic setting compared with the screening setting. Obstet Gynecol. 2008;111(1):7-14.
4. Carwile JL, Feldman S, Johnson NR. Use of a simple visual distraction to reduce pain and anxiety in patients undergoing colposcopy. J Low Genit Tract Dis. 2014;18(4):317-21.
5. Schmid BC, Pils S, Heinze G, Hefler L, Reinthaller A, Speiser P. Forced coughing versus local anesthesia and pain associated with cervical biopsy: a randomized trial. Am J Obstet Gynecol. 2008;199(6):641.e1-3.
6. Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al.; 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis. 2020;24(2):102-131.
7. Baasland I, Hagen B, Vogt C, Valla M, Romundstad PR. Colposcopy and additive diagnostic value of biopsies from colposcopy-negative areas to detect cervical dysplasia. Acta Obstet Gynecol Scand. 2016 Nov;95(11):1258-1263.
8. Davey DD, Neal MH, Wilbur DC, Colgan TJ, Styer PE, Mody DR. Bethesda 2001 implementation and reporting rates: 2003 practices of participants in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology. Arch Pathol Lab Med. 2004;128(11):1224-9.
9. Gage JC, Hanson VW, Abbey K, Dippery S, Gardner S, Kubota J, et al; ASCUS LSIL Triage Study (ALTS) Group. Number of cervical biopsies and sensitivity of colposcopy. Obstet Gynecol. 2006;108(2):264-72.
10. Massad LS. Selecting Patients for Endocervical Curettage. J Low Genit Tract Dis. 2015;19(4):271-2.
11. Pretorius RG, Zhang WH, Belinson JL, Huang MN, Wu LY, Zhang X, et al. Colposcopically directed biopsy, random cervical biopsy, and endocervical curettage in the diagnosis of cervical intraepithelial neoplasia II or worse. Am J Obstet Gynecol. 2004;191(2):430-4.
12. Chen Q, Du H, Pretorius RG, Wang C, Yang B, Wang G, et al. High-Grade Cervical Intraepithelial Neoplasia Detected by Colposcopy-Directed or Random Biopsy Relative to Age, Cytology, Human Papillomavirus 16, and Lesion Size. J Low Genit Tract Dis. 2016;20(3):207-12.
13. Goksedef BP, Akbayir O, Numanoglu C, Corbacioglu A, Guraslan H, Bakir LV, et al. Evaluation of endocervical canal in women with minimal cervical cytological abnormalities. J Low Genit Tract Dis. 2013;17(3):261-6.
14. Liu AH, Walker J, Gage JC, Gold MA, Zuna R, Dunn ST, et al. Diagnosis of Cervical Precancers by Endocervical Curettage at Colposcopy of Women With Abnormal Cervical Cytology. Obstet Gynecol. 2017;130(6):1218-1225.
15. Gage JC, Duggan MA, Nation JG, Gao S, Castle PE. Detection of cervical cancer and its precursors by endocervical curettage in 13,115 colposcopically guided biopsy examinations. Am J Obstet Gynecol. 2010;203(5):481.e1-9.
16. Chen Q, Du H, Pretorius RG, Wang C, Yang B, Wang G, et al. High-Grade Cervical Intraepithelial Neoplasia Detected by Colposcopy-Directed or Random Biopsy Relative to Age, Cytology, Human Papillomavirus 16, and Lesion Size. J Low Genit Tract Dis. 2016;20(3):207-12.
17. Song Y, Zhao YQ, Zhang X, Liu XY, Li L, Pan QJ, et al. Random biopsy in colposcopy-negative quadrant is not effective in women with positive colposcopy in practice. Cancer Epidemiol. 2015;39(2):237-41.
18. Hu SY, Zhang WH, Li SM, Li N, Huang MN, Pan QJ, et al. Pooled analysis on the necessity of random
4-quadrant cervical biopsies and endocervical curettage in women with positive screening but negative colposcopy. Medicine (Baltimore). 2017;96(17):e6689.
19. Pretorius RG, Belinson JL, Azizi F, Peterson PC, Belinson S. Utility of random cervical biopsy and endocervical curettage in a low-risk population. J Low Genit Tract Dis. 2012;16(4):333-8.
20. Cagle AJ, Hu SY, Sellors JW, Bao YP, Lim JM, Li SM, et al. Use of an expanded gold standard to estimate the accuracy of colposcopy and visual inspection with acetic acid. Int J Cancer. 2010;126(1):156-61.
21. Jach R, Mazurec M, Trzeszcz M, Bartosinska-Dyc A, Galarowicz B, Kedzia W, et al. COLPOSCOPY 2020 - Colposcopy Protocols: A Summary of the Clinical Experts Consensus Guidelines of the Polish Society of Colposcopy and Cervical Pathophysiology and the Polish Society of Gynaecologists and Obstetricians. Ginekol Pol. 2020;91(6):362371.
22. Yilmaza F, Kilincb AN, Baymanc MG, Ünlub Y, Özturk EN. Prognostic Value of Endocervical Curettage at the Time of Colposcopic Assessment of the Uterine Cervix. Journal of Clinical Obstetrics & Gynecology 2023;33(1):22-6.
23. Zhao Y, Zhao F, Hu S, Zhang X, Zhang W, Pan Q,
et al. Value of multi-quadrants biopsy: Pooled analysis of 11 population-based cervical cancer screening studies. Chin J Cancer Res. 2020;32(3):383-394.
24. Wentzensen N, Walker JL, Gold MA, Smith KM, Zuna RE, Mathews C, et al. Multiple biopsies and detection of cervical cancer precursors at colposcopy. J Clin Oncol. 2015;33(1):83-9.
25. Kishi Y, Inui S, Sakamoto Y, Mori T. Colposcopy for postmenopausal women. Gynecol Oncol. 1985;20(1):62-70.
26. Li Y, Luo H, Zhang X, Chang J, Zhao Y, Li J, et al. Development and validation of a clinical prediction model for endocervical curettage decision-making in cervical lesions. BMC Cancer. 2021;21(1):804.
27. Huh WK, Sideri M, Stoler M, Zhang G, Feldman R, Behrens CM. Relevance of random biopsy at the transformation zone when colposcopy is negative. Obstet Gynecol. 2014;124(4):670-678.
28. Jespersen MM, Booth BB, Petersen LK. Can biopsies be omitted after normal colposcopy in women referred with low-grade cervical cytology? A prospective cohort study. BMC Womens Health. 2021;21(1):394.
29. Yarandi F, Shirali E, Feizabad E, Ramhormoziyan S, Sarmadi S, SadrAmeli M, Arshadi E. Cervical intraepithelial neoplasia in non-16/18 high-risk human papilloma virus positive/cytology negative women: An alternative approach in poor resource areas. Taiwan J Obstet Gynecol. 2023;62(2):299-303.
2. Smith HJ, Leath CA 3rd, Huh WK, Erickson BK. See-and-Treat for High-Grade Cytology: Do Young Women Have Different Rates of High-Grade Histology? J Low Genit Tract Dis. 2016;20(3):243-6.
3. Cantor SB, Cárdenas-Turanzas M, Cox DD, Atkinson EN, Nogueras-Gonzalez GM, Beck JR, et al. Accuracy of colposcopy in the diagnostic setting compared with the screening setting. Obstet Gynecol. 2008;111(1):7-14.
4. Carwile JL, Feldman S, Johnson NR. Use of a simple visual distraction to reduce pain and anxiety in patients undergoing colposcopy. J Low Genit Tract Dis. 2014;18(4):317-21.
5. Schmid BC, Pils S, Heinze G, Hefler L, Reinthaller A, Speiser P. Forced coughing versus local anesthesia and pain associated with cervical biopsy: a randomized trial. Am J Obstet Gynecol. 2008;199(6):641.e1-3.
6. Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al.; 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis. 2020;24(2):102-131.
7. Baasland I, Hagen B, Vogt C, Valla M, Romundstad PR. Colposcopy and additive diagnostic value of biopsies from colposcopy-negative areas to detect cervical dysplasia. Acta Obstet Gynecol Scand. 2016 Nov;95(11):1258-1263.
8. Davey DD, Neal MH, Wilbur DC, Colgan TJ, Styer PE, Mody DR. Bethesda 2001 implementation and reporting rates: 2003 practices of participants in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology. Arch Pathol Lab Med. 2004;128(11):1224-9.
9. Gage JC, Hanson VW, Abbey K, Dippery S, Gardner S, Kubota J, et al; ASCUS LSIL Triage Study (ALTS) Group. Number of cervical biopsies and sensitivity of colposcopy. Obstet Gynecol. 2006;108(2):264-72.
10. Massad LS. Selecting Patients for Endocervical Curettage. J Low Genit Tract Dis. 2015;19(4):271-2.
11. Pretorius RG, Zhang WH, Belinson JL, Huang MN, Wu LY, Zhang X, et al. Colposcopically directed biopsy, random cervical biopsy, and endocervical curettage in the diagnosis of cervical intraepithelial neoplasia II or worse. Am J Obstet Gynecol. 2004;191(2):430-4.
12. Chen Q, Du H, Pretorius RG, Wang C, Yang B, Wang G, et al. High-Grade Cervical Intraepithelial Neoplasia Detected by Colposcopy-Directed or Random Biopsy Relative to Age, Cytology, Human Papillomavirus 16, and Lesion Size. J Low Genit Tract Dis. 2016;20(3):207-12.
13. Goksedef BP, Akbayir O, Numanoglu C, Corbacioglu A, Guraslan H, Bakir LV, et al. Evaluation of endocervical canal in women with minimal cervical cytological abnormalities. J Low Genit Tract Dis. 2013;17(3):261-6.
14. Liu AH, Walker J, Gage JC, Gold MA, Zuna R, Dunn ST, et al. Diagnosis of Cervical Precancers by Endocervical Curettage at Colposcopy of Women With Abnormal Cervical Cytology. Obstet Gynecol. 2017;130(6):1218-1225.
15. Gage JC, Duggan MA, Nation JG, Gao S, Castle PE. Detection of cervical cancer and its precursors by endocervical curettage in 13,115 colposcopically guided biopsy examinations. Am J Obstet Gynecol. 2010;203(5):481.e1-9.
16. Chen Q, Du H, Pretorius RG, Wang C, Yang B, Wang G, et al. High-Grade Cervical Intraepithelial Neoplasia Detected by Colposcopy-Directed or Random Biopsy Relative to Age, Cytology, Human Papillomavirus 16, and Lesion Size. J Low Genit Tract Dis. 2016;20(3):207-12.
17. Song Y, Zhao YQ, Zhang X, Liu XY, Li L, Pan QJ, et al. Random biopsy in colposcopy-negative quadrant is not effective in women with positive colposcopy in practice. Cancer Epidemiol. 2015;39(2):237-41.
18. Hu SY, Zhang WH, Li SM, Li N, Huang MN, Pan QJ, et al. Pooled analysis on the necessity of random
4-quadrant cervical biopsies and endocervical curettage in women with positive screening but negative colposcopy. Medicine (Baltimore). 2017;96(17):e6689.
19. Pretorius RG, Belinson JL, Azizi F, Peterson PC, Belinson S. Utility of random cervical biopsy and endocervical curettage in a low-risk population. J Low Genit Tract Dis. 2012;16(4):333-8.
20. Cagle AJ, Hu SY, Sellors JW, Bao YP, Lim JM, Li SM, et al. Use of an expanded gold standard to estimate the accuracy of colposcopy and visual inspection with acetic acid. Int J Cancer. 2010;126(1):156-61.
21. Jach R, Mazurec M, Trzeszcz M, Bartosinska-Dyc A, Galarowicz B, Kedzia W, et al. COLPOSCOPY 2020 - Colposcopy Protocols: A Summary of the Clinical Experts Consensus Guidelines of the Polish Society of Colposcopy and Cervical Pathophysiology and the Polish Society of Gynaecologists and Obstetricians. Ginekol Pol. 2020;91(6):362371.
22. Yilmaza F, Kilincb AN, Baymanc MG, Ünlub Y, Özturk EN. Prognostic Value of Endocervical Curettage at the Time of Colposcopic Assessment of the Uterine Cervix. Journal of Clinical Obstetrics & Gynecology 2023;33(1):22-6.
23. Zhao Y, Zhao F, Hu S, Zhang X, Zhang W, Pan Q,
et al. Value of multi-quadrants biopsy: Pooled analysis of 11 population-based cervical cancer screening studies. Chin J Cancer Res. 2020;32(3):383-394.
24. Wentzensen N, Walker JL, Gold MA, Smith KM, Zuna RE, Mathews C, et al. Multiple biopsies and detection of cervical cancer precursors at colposcopy. J Clin Oncol. 2015;33(1):83-9.
25. Kishi Y, Inui S, Sakamoto Y, Mori T. Colposcopy for postmenopausal women. Gynecol Oncol. 1985;20(1):62-70.
26. Li Y, Luo H, Zhang X, Chang J, Zhao Y, Li J, et al. Development and validation of a clinical prediction model for endocervical curettage decision-making in cervical lesions. BMC Cancer. 2021;21(1):804.
27. Huh WK, Sideri M, Stoler M, Zhang G, Feldman R, Behrens CM. Relevance of random biopsy at the transformation zone when colposcopy is negative. Obstet Gynecol. 2014;124(4):670-678.
28. Jespersen MM, Booth BB, Petersen LK. Can biopsies be omitted after normal colposcopy in women referred with low-grade cervical cytology? A prospective cohort study. BMC Womens Health. 2021;21(1):394.
29. Yarandi F, Shirali E, Feizabad E, Ramhormoziyan S, Sarmadi S, SadrAmeli M, Arshadi E. Cervical intraepithelial neoplasia in non-16/18 high-risk human papilloma virus positive/cytology negative women: An alternative approach in poor resource areas. Taiwan J Obstet Gynecol. 2023;62(2):299-303.
| Files | ||
| Issue | Vol 18, No 2 (June 2024) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/jfrh.v18i2.15934 | |
| Keywords | ||
| Colposcopy Curettage Uterine Cervical Dysplasia Early Detection of Cancer | ||
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How to Cite
1.
Ghahghaei-Nezamabadi A, Tehranian A, Feizabad E, Nikabadi P. The Effect of Random Biopsy and Endo-Cervical Curettage in Diagnosis of Precancerous Cervical Lesions in Women With Normal Colposcopy. J Family Reprod Health. 2024;18(2):108-114.
