Richard Hopley, M.D. | 01/24/2024To avoid under-diagnosis of cervical intraepithelial neoplasia (CIN) or malignancy, liberal (all 4 quadrant) colposcopic biopsies are recommended. However, pain and traumatic bleeding are powerful demotivators to both the clinician and the patient in achieving this goal.
A less traumatic biopsy would obviously be more desirable; however, the quality of the tissue sampled would also have to be unaffected. Two new endocervical and exocervical fabric based biopsy tools are now available, and a recent study aimed to compare pain, bleeding and tissue yield with these tools against the conventional punch biopsy and endocervical curettage.
47 ectocervical biopsies (16 conventional punch biopsies, 31 fabric based) and 55 endocervical biopsies (19 conventional curettages, 36 fabric based) were performed for comparison. Pain and bleeding were rated from 0 to 10 (10 being severe pain or bleeding requiring intervention, 0 being no pain or bleeding.)
The results were significant. A pain rating of zero for the fabric based biopsies, versus 4/10 for conventional punch biopsies. A pain rating of 2/10 for fabric based ECCs, versus 6/10 for their conventional counterpart. Bleeding rates were also significantly lower for the fabric based biopsies.
In these days of billboards advertising ‘minimally invasive’ surgeries and even ‘painless dentistry,’ biopsy techniques that deliver less pain and bleeding are welcomed by both the patient and the servicing physician. In addition, increased tolerance of the procedure may lead to a more complete and accurate colposcopy. The bottom line; happier patients, a more thorough colposcopic evaluation and greater disease detection.
Bibliography
1. Fabric-Based Exocervical and Endocervical Biopsy in Comparison With Punch Biopsy and Sharp Curettage. Winter M, Cestero RM, Burg A, Felix JC, Han C, Raffo AM, Vasilev S. 2012, Journal of Lower Genital Tract Disease, pp. 80-87.