Richard Hopley, M.D. | 11/01/2013To avoid underdiagnosis of cervical intraepithelial neoplasia (CIN) or malignancy, liberal use of colposcopic biopsy is recommended (as well as additional random biopsies, described within the additional article in this edition.) 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 (Winter M, 2012) aimed to compare pain, bleeding and tissue yield with these tools against the conventional punch biopsy and endocervical curettage.
47 exocervical 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). Bleeding was not rated within the endocervical curettage arm of the study. (This was because any level of intervention within the endocervical curettage can cause disproportionate, almost unpredictable bleeding, seen even with cotton swabs).
The results are summarized within the below table.
Clearly, the fabric based biopsy caused significantly less bleeding and pain than its conventional counterparts, while obtaining adequate tissue for histologic evaluation.
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.