Assessing the clinical value of cervical biopsies in individuals with transformation zone type 3 at colposcopy: A cross-sectional study.

INTRODUCTION

To evaluate the diagnostic performance of systematic multiple biopsies in individuals with a transformation zone type 3 (TZ3) at colposcopy and to assess the influence of referral status and the use of dynamic spectral imaging (DSI) colposcopy on the detection of CIN2+ lesions.

MATERIAL AND

METHODS

In this multicentre cross-sectional study, a total of 189 individuals referred with abnormal cytology and/or hrHPV positivity with a TZ3 at colposcopy were included at three colposcopy clinics in the Central Denmark Region. Data were obtained from questionnaires, electronic medical records and the Danish National Pathology Registry. All participants underwent colposcopy with four cervical biopsies. Histological outcomes were based on the combined results of all four biopsies and, when available, compared with the corresponding large loop excision of the transformation zone (LLETZ) specimens. One centre employed DSI colposcopy, while two centres used conventional colposcopy. Main outcome measures were CIN2+ detection rate and sensitivity of individual and combined biopsies, assessed overall and stratified by referral status and colposcopy method.

RESULTS

The overall CIN2+ detection rate was 16.9%. The detection rate increased with each additional biopsy, with the highest sensitivity observed at the fourth biopsy (71.4%). The detection rate was significantly higher among individuals referred with high-grade abnormalities (42.6%) compared with low-grade referrals (6.4%) (p < 0.001). The use of DSI colposcope did not significantly improve biopsy sensitivity. Concordance between biopsy and LLETZ histology was 85.3%.

CONCLUSIONS

Systematic multiple biopsies improve CIN2+ detection in women with TZ3 but may lead to overtreatment in those referred with low-grade abnormalities. Despite this approach, the true CIN2+ detection rate may still be underestimated.