| ObjectivesCervical cancer is the 2nd most common malignant cancer in women worldwide, which seriously endanger the health and life of a woman. It is a gynecological malignancy which can be early diagnosed and early treated. The three-step screening program, including cytology, colposcopy and cervical biopsy, is by far the most important tool in detecting cervical cancer and precancerous lesions. Targeting at Macau citizens and collecting cases in Centro Hospitalar de Conde de Sao Januario (CHCSJ), it is to explore the accuracy of colposcopy directed biopsy taken at different locations in diagnosing cervical cancer and precancerous diseases.MethodThe patients who attended the colposcopy clinic from 1st October 2009 to 16th July 2010 in the Department of O&G of CHCSJ in Macau were included. Clinical history was collected and colposcopy was performed. Multiple biopsies were taken at the center of the lesions, margin of the lesions and 3,6,9,12 o'clock at the transformation zone. It was regarded as positivie when the pathological results were classified as cervical intraepithelial neoplasiaâ…¡(CINII) and above. It was to compare the positive detection rate of cervical cancer and precancerous lesions by biopsies taken at different locations. It was to appraise the consistency of pathology study of cervical biopsies with that of cervical conization.Results1. Biopsies were taken at the center of the lesions, margin of the lesion and 3,6,9,12 o'clock of the cervix. The positive finding of CINâ…¡and above was 22.8%,16.3% and 9.3% respectively. Analyzed by X2 test, there was no significant difference of the positive finding between biopsy taken at the center of the lesions and margin of the lesion, P=0.267, and between biopsy taken at margin of the lesion and at 3,6,9,12 o'clock,P= 0.154. However, there was significant difference between biopsy taken at the center of the lesions and at 3,6,9,12 o'clock, P=0.01. 2. Combination of the pathological results of cervical biopsies taken at the center of the lesions with those from margin of the lesion or those from 3,6,9,12 o'clock of the cervix was done. If there were 2 or more than 2 pathological diagnosis, the higher grade would be selected. Then comparison was done with the pathlogical results grading as CINâ…¡and above at the center of the lesions. Analyzed by X2 test, there was no significant difference between the groups, P=0.62 and P=0.74.3. The coincidence rate between colposcopic biopsy and Large loop excision of transformation zone (LLETZ) or cone biopsy in CINII group was 92.31%, whereas the coincidence rate between colposcopic biopsy and LLETZ or cone biopsy in CINâ…¢group was 91.67%. The overall coincidence rate in CINâ…¡andâ…¢was 92.0%.4. There were 24.8% cases being diagnosed as CINâ…¡and above by colposcopy, while there were 27.7% being confirmed by pathological study. Analyzed by X2 test, there was no significant difference between of the results found by colposcopy and by pathological study, P=0.631.5. The sensitivity, specificity, positive predictive value, and negative predictive value of colposcopy in diagnosing CINâ…¡and above was 57.1%,87.7%,64.0% and 84.2% respectively. The diagnosis accordance index was 44.8.ConclusionIt was found in this study that biopsies taken at the center of the lesions had higher positive detection rate than those taken at the margin of the lesions and 3,6,9,12 o'clock of the cervix, with high coincidence rate with cervical cone biopsy. Taking biopsies outside the lesions did not increase the detection rate of cervical precancerous lesions. Therefore, it is mandatory to take cervical biopsies under colposcopy guide. It is crucial to have continuous training and to accumulate the clinical experience. Correct targeting at the lesions with pathological examination, coped with endocervical curettage if necessary, is important to improve the accuracy of diagnosis. Besides it is also critical to have long term follow up, so as to minimize the misdiagnosis and to discover any relapse as early as possible.
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