Colposcopically directed biopsy, random cervical biopsy, and endocervical curettage in the diagnosis of cervical intraepithelial neoplasia II or worse

Objectives: The purpose of this study was to determine the relative importance of colposcopically directed biopsy, random biopsy, and endocervical curettage (ECC) in diagnosing >= cervical intraepithelial neoplasia (CIN) II. Study design: During a screening study, 364 women with satisfactory colposcopy and >= CIN II were diagnosed. All colposcopically detected lesions were biopsied. If colposcopy showed no lesion in a cervical quadrant, a random biopsy was obtained at the squamocolumnar junction in that quadrant. ECC was then performed. Results: The diagnosis of >= CIN II was made on a colposcopically directed biopsy in 57.1%, random biopsy in 37.4%, and ECC in 5.5% of women. The yield of >= CIN II for random biopsy when cytology was high grade (17.6%) exceeded that when cytology was low grade (2.8%). One of 20 women diagnosed solely by ECC had invasive cancer. Conclusion: Even when colposcopy is satisfactory, ECC should be performed. If cytology is high grade, random biopsies should be considered. (C) 2004 Elsevier Inc. All rights reserved.