Random biopsy in colposcopy-negative quadrant is not effective in women with positive colposcopy in practice

To assess the efficacy of random biopsy in diagnosing those high-grade squamous intraepithelial lesions or carcinomas (HSIL+) missed by colposcopy-directed biopsy, and to identify the scenarios of cervical cancer screening when random biopsy is necessary.

Data from 1997 women who participated in the Shanxi Province Cervical Cancer Screening Study I (SPOCCS I) were reviewed. Each woman received human papillomavirus (HPV) testing with the second-generation hybrid capture, liquid-based cytology, four-quadrant biopsy and endocervical curettage. The final diagnosis was based on the most severe pathological result obtained. The efficacy of random biopsy and colposcopy-directed biopsy was evaluated on the basis of the final pathological results.

For women with severe cytological abnormalities (HSIL+) and negative colposcopy, the yield of HSIL+ diagnosed by random biopsy was 25%. On the other hand, the yield of HSIL+ diagnosed by random biopsies in the negative quadrant was no more than 4% when the colposcopy was positive, regardless of the cytological findings. For women with negative HPV, no HSIL+ was found by random biopsy. For women with severe cytological abnormalities (HSIL+) and positive HPV, the yield of HSIL+ diagnosed by random biopsy was 35% when colposcopy was negative. For women with low-grade intraepithelial lesion (LSIL) and positive HPV, the yield of HSIL+ diagnosed by random biopsy was 12.5% when colposcopy was negative.

Random biopsy is not effective in the negative quadrant in women with positive colposcopy, but should be performed in women with cytological HSIL+ but negative colposcopy, or in those with cytological LSIL or HGSL+ and positive HPV but negative colposcopy.