Relevance of random biopsy at the transformation zone when colposcopy is negative

Warner K. Huh, Mario Sideri, Mark Stoler, Guili Zhang, Robert Feldman, Catherine M. Behrens

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

OBJECTIVE: A post hoc analysis to determine the diagnostic yield of random biopsy in detecting high-grade cervical disease in women with negative colposcopy.

METHODS: The ATHENA (Addressing the Need for Advanced HPV Diagnostics) trial screened more than 47,000 women with cytology and high-risk human papillomavirus (HPV) DNA genotyping. Colposcopy was performed in all women with abnormal cytology or positive HPV results. A single random biopsy was taken at the squamocolumnar junction if colposcopy was adequate and no lesions were identified.

RESULTS: The random biopsy diagnosed 20.9% (81/388, 95% confidence interval [CI] 16.9-25.3%) and 18.9% (45/ 238, 95% CI 14.1-24.5%) of the total cervical intraepithelial neoplasia (CIN) grade 2 or worse and grade 3 or worse, respectively. This additional disease was detected in both HPV 16 or 18+ and for 12 other high-risk HPV+ women. For HPV 16 or 18, the absolute risk for detection of CIN 2 or worse on random biopsy in the overall population was 13.1% (40/305, 95% CI 9.8-17.4%) and 8.2% (25/305, 95% CI 5.6-11.8%) for CIN 3 or worse. By contrast, the absolute risk for 12 other high-risk HPV+ women was 3.5% (29/820, 95% CI 2.5-5%) and 1.7% (14/820, 95% CI 1.0-2.8%) for CIN 2 or worse and CIN 3 or worse, respectively.

CONCLUSION: A single random biopsy increased the detection of high-grade disease when no lesions were visualized at colposcopy. The absolute risks of disease associated with the random biopsy were highest for women positive for genotype 16 or 18. Our study supports performing a random biopsy in women undergoing colposcopy without visible lesions, particularly in those positive for HPV 16 or 18.

Original languageEnglish
Pages (from-to)670-678
Number of pages9
JournalObstetrics and Gynecology
Volume124
Issue number4
DOIs
Publication statusPublished - Oct 10 2014

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Colposcopy
Cervical Intraepithelial Neoplasia
Biopsy
Confidence Intervals
Human papillomavirus 18
Human papillomavirus 16
Cell Biology
Genotype
DNA
Population

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Medicine(all)

Cite this

Huh, W. K., Sideri, M., Stoler, M., Zhang, G., Feldman, R., & Behrens, C. M. (2014). Relevance of random biopsy at the transformation zone when colposcopy is negative. Obstetrics and Gynecology, 124(4), 670-678. https://doi.org/10.1097/AOG.0000000000000458

Relevance of random biopsy at the transformation zone when colposcopy is negative. / Huh, Warner K.; Sideri, Mario; Stoler, Mark; Zhang, Guili; Feldman, Robert; Behrens, Catherine M.

In: Obstetrics and Gynecology, Vol. 124, No. 4, 10.10.2014, p. 670-678.

Research output: Contribution to journalArticle

Huh, WK, Sideri, M, Stoler, M, Zhang, G, Feldman, R & Behrens, CM 2014, 'Relevance of random biopsy at the transformation zone when colposcopy is negative', Obstetrics and Gynecology, vol. 124, no. 4, pp. 670-678. https://doi.org/10.1097/AOG.0000000000000458
Huh, Warner K. ; Sideri, Mario ; Stoler, Mark ; Zhang, Guili ; Feldman, Robert ; Behrens, Catherine M. / Relevance of random biopsy at the transformation zone when colposcopy is negative. In: Obstetrics and Gynecology. 2014 ; Vol. 124, No. 4. pp. 670-678.
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abstract = "OBJECTIVE: A post hoc analysis to determine the diagnostic yield of random biopsy in detecting high-grade cervical disease in women with negative colposcopy.METHODS: The ATHENA (Addressing the Need for Advanced HPV Diagnostics) trial screened more than 47,000 women with cytology and high-risk human papillomavirus (HPV) DNA genotyping. Colposcopy was performed in all women with abnormal cytology or positive HPV results. A single random biopsy was taken at the squamocolumnar junction if colposcopy was adequate and no lesions were identified.RESULTS: The random biopsy diagnosed 20.9{\%} (81/388, 95{\%} confidence interval [CI] 16.9-25.3{\%}) and 18.9{\%} (45/ 238, 95{\%} CI 14.1-24.5{\%}) of the total cervical intraepithelial neoplasia (CIN) grade 2 or worse and grade 3 or worse, respectively. This additional disease was detected in both HPV 16 or 18+ and for 12 other high-risk HPV+ women. For HPV 16 or 18, the absolute risk for detection of CIN 2 or worse on random biopsy in the overall population was 13.1{\%} (40/305, 95{\%} CI 9.8-17.4{\%}) and 8.2{\%} (25/305, 95{\%} CI 5.6-11.8{\%}) for CIN 3 or worse. By contrast, the absolute risk for 12 other high-risk HPV+ women was 3.5{\%} (29/820, 95{\%} CI 2.5-5{\%}) and 1.7{\%} (14/820, 95{\%} CI 1.0-2.8{\%}) for CIN 2 or worse and CIN 3 or worse, respectively.CONCLUSION: A single random biopsy increased the detection of high-grade disease when no lesions were visualized at colposcopy. The absolute risks of disease associated with the random biopsy were highest for women positive for genotype 16 or 18. Our study supports performing a random biopsy in women undergoing colposcopy without visible lesions, particularly in those positive for HPV 16 or 18.",
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