Use of colposcopically directed, four-quadrant cervical biopsy by the colposcopy trainee

Colposcopically directed cervical biopsies performed by experienced colposcopists have greatly reduced the need for conization of the cervix to evaluate patients with cervical intraepithelial neoplasia (CIN). Because of the subjectivity of the colposcopic technique and variable time required to become skilled, continued reliance on cervical conization is often recommended to validate colposcopic findings for novice colposcopists . We assessed the colposcopic skill of residents in training in obstetrics and gynecology who had received 9-12 months of instruction in colposcopic techniques. Biopsies of each quadrant of the ectocervix were done after the resident recorded his or her colposcopic diagnosis. In 26% of the patients there was overestimation or underestimation of the histologic findings by more than one grade in the cervical quadrant suspected on colposcopy to contain the most advanced CIN lesion. In 30% of patients the histologically most advanced CIN lesion was not identified by the colposcopist . In 11% of patients with histologic findings of CIN both cytology and colposcopy were negative. Only 69% of the histologically confirmed lesions were diagnosed colposcopically by the resident colposcopists . The four-quadrant, colposcopically directed biospy technique is recommended as an effective training method for the beginning colposcopist .