Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jul;61(4):477-488.
doi: 10.5468/ogs.2018.61.4.477. Epub 2018 Jun 28.

Clinical factors that affect diagnostic discrepancy between colposcopically directed biopsies and loop electrosurgical excision procedure conization of the uterine cervix

Yuyeon Jung  1 , Ah Ra Lee  2 , Sung-Jong Lee  1 , Yong Seok Lee  2 , Dong Choon Park  1 , Eun Kyung Park  2
Affiliations

Clinical factors that affect diagnostic discrepancy between colposcopically directed biopsies and loop electrosurgical excision procedure conization of the uterine cervix

Yuyeon Jung et al. Obstet Gynecol Sci. 2018 Jul.

Abstract

Objective: This study aimed to determine the factors affecting pathologic discrepancy and final diagnosis between colposcopic biopsy and pathology by loop electrosurgical excision procedure (LEEP).

Methods: Between 2004 and 2016, 1,200 patients who underwent LEEP were enrolled for this study. 667 underwent cervical cytology, human papillomavirus (HPV) test, colposcopic biopsy, and LEEP. We analyzed patient's age, menopausal status, number of delivery, abortion times, cervical cytology, number of punch biopsies, HPV type, LEEP, and interval between colposcopic biopsy and LEEP.

Results: Logistic regression analysis of the final diagnosis showed that age 30-39 years and other high HPV group types were associated with cancer diagnosis, whereas atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), high-grade squamous intraepithelial lesion (HSIL), and HPV type 16 affected the diagnosis of cervical intraepithelial neoplasia (CIN) 2. The overall concordance rate of histopathology between punch biopsy and LEEP was 43.3%. The rates of detecting a more severe lesion by LEEP than those by biopsy were 23.1%. The rates of a less severe lesion detected by LEEP than those by biopsy were 33.6%. Factors related with biopsy underestimation were as follows: <1 vaginal delivery, HSIL, number of punch biopsies and HPV type. Punch biopsy number is a unique factor of biopsy overestimation.

Conclusion: Patients with ASC-H, HSIL, and HPV type 16 may undergo conization immediately without colposcopic biopsy. We suggest that colposcopically directed 3 to 5 punch biopsies may be used to determine the need for conization.

Keywords: Biopsy; Cervical intraepithelial neoplasia; Conization; Papanicolaou test.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: No potential conflict of interest relevant to this article was reported.

References

    1. Duesing N, Schwarz J, Choschzick M, Jaenicke F, Gieseking F, Issa R, et al. Assessment of cervical intraepithelial neoplasia (CIN) with colposcopic biopsy and efficacy of loop electrosurgical excision procedure (LEEP) Arch Gynecol Obstet. 2012;286:1549–1554. - PubMed
    1. Giannella L, Mfuta K, Gardini G, Rubino T, Fodero C, Prandi S. High-grade CIN on cervical biopsy and predictors of the subsequent cone histology results in women undergoing immediate conization. Eur J Obstet Gynecol Reprod Biol. 2015;186:68–74. - PubMed
    1. Livasy CA, Moore DT, Van Le L. The clinical significance of a negative loop electrosurgical cone biopsy for high-grade dysplasia. Obstet Gynecol. 2004;104:250–254. - PubMed
    1. Rodriguez-Manfredi A, Alonso I, del Pino M, Fusté P, Torné A, Ordi J. Predictors of absence of cervical intraepithelial neoplasia in the conization specimen. Gynecol Oncol. 2013;128:271–276. - PubMed
    1. Witt BL, Factor RE, Jarboe EA, Layfield LJ. Negative loop electrosurgical cone biopsy finding following a biopsy diagnosis of high-grade squamous intraepithelial lesion: frequency and clinical significance. Arch Pathol Lab Med. 2012;136:1259–1261. - PubMed

LinkOut - more resources