Multiple Biopsies Increases Cervical Cancer Precursor Detection

Multiple lesion-directed biopsies can drastically improve the sensitivity of colposcopy in women referred for abnormal cervical cancer screening.

Multiple lesion-directed biopsies can drastically improve the sensitivity of colposcopy in women referred for abnormal cervical cancer screening, according to a new study. Taking additional biopsies when possible should be considered standard practice.

“Typically, colposcopy results are characterized by a colposcopic impression and by selection of the worst-appearing site for biopsy,” wrote study authors led by Nicolas Wentzensen, MD, PhD, of the National Cancer Institute in Bethesda, Maryland. There has been no systematic study quantifying any improvement in detection of cervical cancer precursors known as high-grade squamous intraepithelial lesions (HSILs) with more than one biopsy site. “The lack of consensus about colposcopic practice in the United States is reflected by a wide variation of colposcopy-biopsy procedures.”

The Biopsy Study included 690 women referred to colposcopy following an abnormal cervical cancer screen result. Up to four directed biopsies were taken in each woman, and a nondirected biopsy of a normal-appearing area was also included in patients with fewer than four biopsies. Results were published in the January 1 issue of the Journal of Clinical Oncology.

In the full cohort, the sensitivity for detecting HSIL was 60.6% with only one biopsy. This rose to 85.6% with two biopsies, and to 95.6% after three biopsies. “The estimated proportion of women who would have an HSIL diagnosis in the overall population increased from 0.24 for taking one biopsy to 0.39 for taking four biopsies,” the authors wrote.

Increases in sensitivity with more biopsies were seen across all patient subgroups. The biggest increases occurred in those with high-grade colposcopic impression, HSIL cytology, and HPV type 16 positivity. In the HPV 16-positive women (185 patients), sensitivity of HSIL detection rose from 72.6% with one biopsy to 100% with four biopsies.

Though the benefit of the additional biopsies seems clear, the authors did note that associated harms should also be considered. These could include discomfort and additional costs.

“Our findings reaffirm the importance of colposcopy and lesion-directed biopsy and have important implications for clinical practice,” they concluded. “The full benefit of earlier detection of HSIL by screening using HPV testing will depend on improvement and standardization of colposcopy.” At least two or three biopsies should be taken based on these results.

Study Details

The median age of women in the study was 26 years. All women had at least one biopsy, with 54.6% undergoing four biopsies, 26.6% had three, and 18.8% had fewer than three. Of the full cohort, 189 patients were positive for HPV-16, 348 were positive for carcinogenic HPV but not HPV-16, and 86 were positive for non-carcinogenic HPV.