Multiple biopsies are superior to a single biopsy in detecting cervical cancer precursors

Performing multiple biopsies during a procedure known as colposcopy—visual inspection of the cervix—is more effective than performing only a single biopsy of the worst-appearing area for detecting cervical cancer precursors. This multiple biopsy approach may help to detect disease early and avoid repeated biopsies for women with initial negative findings, according to a new study by researchers at the National Cancer Institute and their colleagues. Women with abnormal results on cervical cancer screening, which is usually done via scraping cells from the surface of the cervix, are referred for colposcopy and biopsy to detect cervical cancer precursors (typically classified as high-grade squamous intraepithelial lesions, or HSIL). The biopsy results determine whether excision of the lesion is required. Colposcopy with a single biopsy can fail to detect HSIL. This study involved 690 women who had up to four distinct lesions biopsied. The sensitivities for detecting HSIL increased from 60.6 percent for a single biopsy to 85.6 percent for two biopsies to 95.6 percent for three biopsies.

In the study, women 18 years or older with abnormal cervical cancer screening results were enrolled and treated at the University of Oklahoma Health Sciences Center, Oklahoma City, between February 2009 and September 2012. The study report appeared Nov. 24, 2014, in the Journal of Clinical Oncology. Performing additional biopsies when multiple lesions are present on the cervix should become standard practice, concluded lead author Nicolas Wentzensen, M.D., Ph.D., Division of Cancer Epidemiology and Genetics, NCI. Each year in the United States, about three million women are evaluated with colposcopic procedures by gynecologic experts. Often, only the worst-appearing area on the surface of the cervix is selected for biopsy.