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CC BY 4.0 · Rev Bras Ginecol Obstet 2022; 44(03): 272-279
DOI: 10.1055/s-0042-1744212
Original Article
Lower Genital Tract Diseases

When is There no Benefit in Performing a Biopsy in the Suspicion of Intraepithelial Lesions of the Cervix?

Quando não há benefício em realizar biópsia na suspeita de lesões intraepiteliais do colo uterino?
Marília Porto Bonow 
1   Department of Obstetrics and Gynecology, Clinics Hospital of the University of Paraná, Curitiba, PR, Brazil
,
Luiz Martins Collaço 
2   Department of Pathology of Clinics Hospital of the University of Paraná, Curitiba, PR, Brazil
,
Ana Paula Percicote 
2   Department of Pathology of Clinics Hospital of the University of Paraná, Curitiba, PR, Brazil
,
Rita Maira Zanine 
3   Department of Gynecology and Obstetrics, Lower Genital Tract Disease and Colposcopy Sector, Clinics Hospital of the University of Paraná, Curitiba, PR, Brazil
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Abstract

Objective To evaluate whether colposcopy-directed biopsy is necessary to increase the accuracy of diagnosing cervical intraepithelial lesions in relation to colposcopy.

Methods We performed a retrospective, observational study by analyzing medical records obtained from Hospital de Clínicas do Paraná from February 2008 to February 2018. Patients with results of Pap tests, colposcopy, colposcopy-directed biopsy, and surgical procedures (high-frequency surgery or cold conization) were included. Data such as quadrants involved during colposcopy and age differences were also analyzed.

Results A total of 299 women were included. Colposcopy was found to have an accuracy rate of 76.25% (95% confidence interval [CI], 71.4–81.1). Among the highest-grade lesions, the accuracy rate was 80.5% (95% CI, 75.7–85.3). The accuracy rates for biopsy were 79.6% (95% CI, 75–84.2) and 84.6% (95% CI, 80–89.1) for the highest-grade lesions. High-grade lesions were accurately confirmed in 76.9% and 85% of patients with 1 and 2 or more affected quadrants, respectively. For women younger than 40 years, the accuracy rates were 77.6% and 80.8% for colposcopy and biopsy, respectively. For women 40 years or older, the accuracy rates were 72.5% and 76.3% for colposcopy and biopsy, respectively.

Conclusion There is no difference between the accuracy of colposcopy and that of biopsy in diagnosing cervical intraepithelial lesions in relation with the result of conization. The patients who received the greatest benefit when biopsy was not performed were those with high-grade lesions at colposcopy, a lesion involving 2 or more quadrants, and those younger than 40 years.

Resumo

Objetivo Avaliar se a biópsia colpodirigida é necessária para aumentar a acurácia diagnóstica nas lesões intraepiteliais de colo uterino em relaçãoà colposcopia.

Métodos Estudo retrospectivo, observacional, incluindo pacientes submetidas a colposcopia, biópsia colpodirigida, e procedimento cirúrgico (cirurgia de alta frequência ou conização a frio), no período de fevereiro de 2008 a fevereiro de 2018, no Hospital de Clínicas da Universidade Federal do Paraná. Dados como número de quadrantes da lesão presentes na colposcopia, número de fragmentos retirados nas biópsias e diferenças por idade também foram analisados.

Resultados Um total de 299 mulheres foram incluídas. Foi encontrada uma acurácia de 76,25% (intervalo de confiança [IC] 95% 71,4–81,1) entre a colposcopia e a conização, sendo 80,5% % (IC 95% 75.7–85.3) nas lesões de maior grau. A acurácia da biópsia foi de 79,6% (IC 95% 75–84,2), sendo 84,6% (IC 95% 80–89,1) nas lesões de maior grau. Pacientes com 1 quadrante acometido tiveram confirmação de 76,9% nas lesões de maior grau, enquanto as com 2 quadrantes acometidos apresentaram o mesmo resultado em 85% dos casos. A acurácia com a biópsia de 1 fragmento foi de 78% e com 2 ou mais fragmentos 80%. Para mulheres com menos de 40 anos, a acurácia foi de 77,6% e 80,8% para colposcopia e biópsia, respectivamente. Para mulheres com 40 anos ou mais, a acurácia foi de 72,5% e 76,3% para colposcopia e biópsia, respectivamente.

Conclusão Não há diferença entre a acurácia da colposcopia e a da biópsia colpodirigida no diagnóstico de lesões intraepiteliais cervicais em relação ao resultado da conização. As pacientes que tiveram o maior benefício quando a biópsia não foi realizada foram as que apresentaram lesão de alto grau na colposcopia e aquelas com menos de 40 anos, não existindo benefício em realizar biópsia previamente a conização neste grupo de pacientes.

Keywords

cervical intraepithelial neoplasia - colposcopy-directed biopsy - conization - cervical cancer

Palavras-chave

neoplasia intraepitelial cervical - biópsia colpodirigida - conização - câncer cervical

Contributions

All authors participated in the concept and design of the present study; in the analysis and interpretation of data; in the draft or revision of the manuscript; and they have approved the manuscript as submitted. All authors are responsible for the reported research.




Publikationsverlauf

Eingereicht: 07. April 2021

Angenommen: 03. Januar 2022

Artikel online veröffentlicht:
16. Mai 2022

© 2022. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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