Role of Multiple Cervical Biopsies on Colposcopy for the Detection of Premalignant and Malignant Lesions of the Cervix

Introduction: Cervical cancer screening is done by various methods like pap smear testing, visual inspection with acetic acid (VIA) and visual inspection with lugol’s iodine (VILI), and HPV DNA testing. All screen-positive women are subjected to colposcopy, and colposcopic-directed biopsy is taken from the abnormal area, and sent for histopathology, which is the gold standard for diagnosing premalignant and malignant lesions cervix. Colposcopy has some limitations because it is a subjective test, and its accuracy relies on the physician’s experience and performance to a great extent. To improve the detection of cervical intraepithelial neoplasia (CIN)2+ lesions various studies have suggested taking multiple cervical biopsies from colposcopy-positive as well as negative areas. Objective: To study the role of four quadrant cervical biopsy on colposcopy to detect premalignant and malignant lesions of the cervix. Materials and Methods: This cross-sectional study was carried out on 100 women after obtaining ethics committee approval. Women in the age group of 21–65 years with any of the screening tests positive and with abnormal colposcopic findings were subjected to four quadrants cervical biopsy, directed biopsy from colposcopically abnormal quadrant and nondirected biopsy from colposcopically normal quadrant along with endocervical curettage (ECC). Results: The mean age was 41.27 years and most women had an age <20 years at the time of first sexual contact. About 95% of women had parity ≥3. On nondirected biopsy, 33.6% of premalignant lesions and 1% of malignant lesions were picked up, while 37.8% of lesions were benign on directed biopsy. Twelve percent additional CIN lesions were picked up by nondirected biopsy which could have been missed by directed biopsy. ECC in our study could pick up 2% of CIN lesions when Transformation Zone (TZ) was type 1, while 10% of CIN lesions were picked up in TZ type 2/3. The sensitivity, specificity, positive predictive value, and negative predictive value of colposcopy in predicting premalignant and malignant lesions of the cervix using the Modified Reid Colposcopic Index were 51.7%, 46.8%, 47.6%, and 50.9% respectively. Conclusions: In addition to biopsies from colposcopy-positive areas, biopsies should be taken from colposcopy-negative quadrants of the cervix in women with abnormal screening tests. ECC should be performed when the TZ type is 2/3.