There is an ongoing debate about the best approach to colposcopy-biopsy to follow up positive cervical cancer screening results. Proposed strategies range from taking a biopsy only from the worst appearing lesion to taking four-quadrant biopsies irrespective of colposcopy impression. While these strategies are often discussed as a uniform approach for the entire colposcopy population, women referred to colposcopy have a wide spectrum of underlying risk of precancer that could influence colposcopic practice and management. For example, at a very low risk of precancer, taking multiple biopsies and targeting normal appearing cervix may not be necessary. At a very high risk of precancer, conversely, immediate treatment may be justified independent of the biopsy outcome.
Analyses of risk-strata based on different combinations of HPV status, cytology, p16/Ki-67, and colposcopic impression in women undergoing colposcopy in the Biopsy Study showed that combinations of test results from primary screening and triage together with colposcopic impression can be used to guide colposcopic practice. Analyses in other studies are currently underway and will be presented at the meeting. Developing risk-based guidelines for colposcopy and biopsy will be important to anticipate changes of current colposcopy populations related to HPV vaccination and HPV-based screening.
n/a
n/a