Expert Commentary

How useful is random biopsy when no colposcopic lesions are seen?

Author and Disclosure Information

About 20% useful to identify otherwise undetected CIN2 or worse or CIN 3 or worse. The absolute risks of disease associated with the random biopsy were higher for women positive for HPV 16 or 18, according to this large post hoc analysis.

Huh WK, Sideri M, Stoler M, Zhang G, Feldman R, Behrens CM. Relevance of random biopsy at the transformation zone when colposcopy is negative. Obstet Gynecol. 2014;124(4):670-678.



When performing colposcopy for abnormal cytology results or high-risk human papillomavirus (HPV), clinicians often are faced with an absence of visible lesions. This situation raises the following question in his or her mind: “Should I perform a random biopsy?”

Details of the study
In a multicenter US study of more than 47,000 women, performed to assess HPV diagnostics between May 2008 and August 2009, colposcopy was performed in nonpregnant women aged 25 or older with an intact uterus due to atypical squamous cells of undetermined significance or greater cytology results or high-risk HPV. The study participants and the colposcopists were blinded to the test results. In women with satisfactory colposcopy results but in whom no colposcopic lesions were noted, one random biopsy of the squamocolumnar junction was performed.

Among 2,796 women (mean age, 39.5 years) with a random biopsy performed, the findings were: normal, cervical intraepithelial neoplasia (CIN)−1, CIN2, and CIN3 in 90.0%, 5.7%, 1.3%, and 1.4%, respectively. Among all participants aged 25 and older, random biopsies accounted for 20.9% and 18.9% of the CIN2 or worse and CIN3 or worse cases, respectively. Among women positive for HPV 16 or 18, the likelihood of the random biopsy detecting CIN2 or worse was 24.7% and 8.6% for those with abnormal cytology or normal cytology, respectively.

What this evidence means for your practice
Consistent with other reports, the results of this post hoc analysis underscore the limitations of colposcopy. Just as results of a prior study indicated that taking two or more biopsies increases diagnostic yield,1 this large study points out the substantial benefit gained from performing a random biopsy of the squamocolumnar junction when no colposcopic lesions are identified.
—Andrew M. Kaunitz, MD

Share your thoughts on this article! Send your Letter to the Editor to Please include your name and the city and state in which you practice.

Next Article:

Ovarian cancer often arises from precursor endometriosis

Related Articles