Can biopsies be omitted after normal colposcopy in women referred with low-grade cervical cytology? A prospective cohort study

Mette Mindedahl Jespersen*, Berit Bargum Booth, Lone Kjeld Petersen

*Corresponding author for this work

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Background: Controversy surrounds whether women with low-risk cytology screening results but a normal colposcopic assessment should have random biopsies taken. The aim of this study was to determine the yield of CIN2+ from one to four cervical biopsies in women with cytology of LSIL or ASCUS and a normal colposcopic impression. Methods: Between January 2017 and September 2020, women over 18 years old referred for colposcopic examination due to either an abnormal smear (ASCUS+) or follow-up after previous cervical intraepithelial neoplasia (CIN) were invited to participate in the study. All study participants underwent colposcopic examination and had four biopsies taken. The biopsies were analyzed separately. Results: In total, 1327 women with abnormal cervical cancer screening results or attending follow-up after a previous CIN diagnosis were enrolled in the study and examined by colposcopy. Of these, 173 were newly referred with cytology of LSIL or ASCUS and had a normal colposcopic impression and four adequate biopsies. Of these, 22.0% were diagnosed with CIN2+. When combining the results of the four biopsies, we found a 100% relative increase in CIN2+ cases compared to using only one biopsy (from 11.0% to 22.0%, P = 0.006). Conclusion: As we found CIN2+ from random cervical biopsies in 22.0% of women with cytology of LSIL or ASCUS who had a normal colposcopic impression, we advocate performing four random cervical biopsies at the squamocolumnar junction in such women. Trial registration NCT04249856, January 31 2020 (retrospectively registered).

Original languageEnglish
Article number394
JournalBMC Women's Health
Pages (from-to)394
Number of pages9
Publication statusPublished - 19. Nov 2021

Bibliographical note

Publisher Copyright:
© 2021, The Author(s).


  • Atypical squamous cells of the cervix
  • Biopsy
  • Cervical intraepithelial neoplasia
  • Colposcopy
  • Conization
  • Diagnosis
  • Precancerous conditions
  • Squamous intraepithelial lesions
  • Prospective Studies
  • Early Detection of Cancer
  • Humans
  • Vaginal Smears
  • Papillomavirus Infections
  • Pregnancy
  • Uterine Cervical Neoplasms/diagnosis
  • Adolescent
  • Female


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