Colposcopic Directed Biopsy in the Management of Abnormal Pap Smear at Phramongkutklao Hospital
Suttida Intharaburan MD*, Ittipat Rakdang MD*, Yawana Tanapat MD*
Affiliation : * Department of Obstetrics and Gynecology, Phramongkutklao Hospital, Bangkok, Thailand
Objective : To evaluate agreement in pathologic diagnosis of tissue obtained by colposcopic directed
biopsy (CDB) and conization or total abdominal hysterectomy (TAH) in the diagnosis of cervical
intraepithelial neoplasia (CIN).
Materials and Methods : Medical records of women with abnormal cervical cytology referred for colposcopic
examination from January 1, 1999 to December 31, 2003 were reviewed. Agreement in diagnosis of CIN
in tissue obtained by CDB and tissue obtained by conization or TAH is defined as not more than one
level of CIN disparity.
Results : Agreement between pathologic diagnosis of tissue from CDB and tissue from conization or TAH
is 67.1% with a 95% confidence interval of 57 - 77%. Six cases of invasive cancer were not diagnosed
from CDB but subsequently diagnosed from conization.
Conclusion : Agreement between pathologic diagnosis of tissue obtained from CDB and tissue from
conization or TAH in the present study was too low to accept CDB as a diagnostic modality for CIN in
selected cases. Conization should be performed in these cases after diagnosis of CIN is made by CDB.
Keywords : Cervical intraepithelial neoplasia, Colposcopic directed biopsy, Loop electrosurgical excision procedure
