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Cervical biopsy sampling variability in ALTS.

Daron G Ferris1, Mark S Litaker

  • 1Gynecologic Cancer Prevention Center, Department of Family Medicine, Medical College of Georgia, Augusta, GA 30912-3500, USA. dferris@mcg.edu

Journal of Lower Genital Tract Disease
|December 21, 2010
PubMed
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Colposcopists generally agree on the need for cervical biopsies but show variability in biopsy site selection. Expert reviewers demonstrate less variability in biopsy site placement for cervical cancer precursors.

Area of Science:

  • Gynecology
  • Cervical Pathology
  • Colposcopy

Background:

  • Atypical Squamous Cells of Undetermined Significance (ASCUS)/Low-grade Squamous Intraepithelial Lesion (LSIL) triage requires accurate colposcopic evaluation.
  • Histologic sampling variability can impact patient management and outcomes.

Purpose of the Study:

  • To assess variability in colposcopic biopsy sampling among clinicians and quality control reviewers.
  • To compare biopsy site indications and locations in the ASCUS/LSIL Triage Study.

Main Methods:

  • Colposcopists and reviewers used custom software with digitized images to indicate biopsy need, number, and location.
  • Agreement was assessed using percentages, κ statistics, McNemar, and paired t tests.

Main Results:

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  • Agreement on biopsy indication was 72.9% overall and 91.6% for CIN2+ lesions.
  • Colposcopists indicated more biopsy sites than reviewers (p < .0001).
  • Mean biopsy site distance from reviewer recommendations was greater for colposcopists (14.9 mm) than between reviewers (12.2 mm).

Conclusions:

  • Most colposcopists biopsy when cervical cancer precursors are suspected.
  • Significant variability exists in biopsy site placement.
  • Expert reviewers exhibit less biopsy site variability.