Cervical Strip Biopsy for High-Grade Cervical Intraepithelial Lesions: a Valid Alternative to Conventional Punch Technique

Abstract

Introduction: To evaluate, if targeted strip biopsies decrease trauma/pain perception while maintaining diagnostic accuracy in patients with the diagnosis of high-grade squamous intraepithelial lesions of the uterine cervix. Patients and Methods: Between July 1st and December 31st 2014 we performed colposcopically directed strip biopsies in 102 patients with colposcopic suspicion of high-grade squamous intraepithelial lesions of the uterine cervix. We used a 3 mm curette for harvesting tissue samples under VITOM® videocolposcopy. So far, 60 patients underwent additional loop excision. Histologic examination of strip biopsies and loop specimens included routine hematoxylin and eosin staining as well as immunohistochemical staining for p16, Ki 67 and stathmin-1. Results: 55 patients (53 %), were histologically diagnosed with cervical intraepithelial neoplasia grade 3 on strip biopsies. Adenocarcinoma in situ was diagnosed in 2 patients (2 %), cervical intraepithelial neoplasia grade 2 in 35 patients (34 %), and cervical intraepithelial neoplasia grade 1 in 10 patients (10 %). The agreement between histologic results of strip biopsy and loop specimen was highly significant: In all 60 strip biopsies diagnosed with high-grade squamous intraepithelial lesions this diagnosis was confirmed histologically during follow-up loop specimen excision (high-grade squamous intraepithelial lesions in 58 patients, invasive disease in 2 patients). The pain level experienced during strip biopsy was rated on average 0.25 on a scale from 0 to 10. No clinically significant bleeding was reported. Conclusion: Targeted strip biopsies with a 3 mm curette are a reliable procedure to diagnose high-grade squamous intraepithelial lesions of the uterine cervix and yield high patient satisfaction (Video 1).

Zusammenfassung

Fragestellung: Können bei Frauen mit V. a. High Grade squamous intraepithelial Lesions der Cervix uteri kolposkopisch gezielt entnommene Streifenbiopsien die Schmerzempfindung vermindern und trotzdem eine hohe diagnostische Sicherheit gewährleisten? Patientinnen und Methoden: Zwischen 1. Juli und 31. Dezember 2014 führten wir bei 104 Patientinnen mit kolposkopischem Verdacht auf High Grade squamous intraepithelial Lesions gezielte Streifenbiopsien durch. Kontrolliert durch VITOM®-Videokolposkopie benutzten wir eine 3-mm-Kürette zur Gewebegewinnung. Bei 60 dieser Patientinnen erfolgte im späteren Verlauf eine Schlingenexzision. Die histologische Untersuchung der Streifenbiopsien und Schlingenexzidate erfolgte mittels Hämatoxylin und Eosin sowie immunhistochemischer Färbung für p16, Ki 67 und stathmin-1. Ergebnisse: Bei 55 Patientinnen (53 %) wurde in der Streifenbiopsie histologisch eine zervikale intraepitheliale Neoplasie Grad 3 diagnostiziert. Adenocarcinoma in situ wurde bei 2 Patientinnen (2 %), zervikale intraepitheliale Neoplasie Grad 2 bei 35 Patientinnen (34 %), und zervikale intraepitheliale Neoplasie Grad 1 bei 10 Patientinnen gefunden (10 %). Die Übereinstimmung der histologischen Ergebnisse zwischen Streifenbiopsie und Schlingenexzidat war exzellent: Alle 60 Streifenbiopsien mit der Diagnose High Grade squamous intraepithelial Lesions wurden am späteren Schlingenexzidat bestätigt (High Grade squamous intraepithelial Lesions bei 58 Patientinnen, Invasion bei 2 Patientinnen). Die Schmerzempfindung während und nach Streifenbiopsie betrug 0.25 im Durchschnitt bei einer Skala zwischen 0 und 10. Keine klinisch auffällige Blutung wurde festgestellt. Schlussfolgerung: Gezielte Streifenbiopsien mit einer 3-mm-Kürette bilden eine zuverlässige Methode zur Diagnose von High Grade squamous intraepithelial Lesions verbunden mit einer hohen Patientinnenzufriedenheit (Video 2).

Key words

high-grade SIL - strip biopsy - painless

Schlüsselwörter

High Grade SIL - Streifenbiopsie - schmerzlos

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