The risk of recurrence of high-grade squamous intraepithelial lesions and its association with the number of colposcopic biopsies
Colposcopy is an important exam for diagnosing intraepithelial lesions and cervical cancer, but it has limitations. The sensitivity for detecting high-grade squamous intraepithelial lesions (HSIL) increases with the number of punch biopsy fragments collected. However, there is no consensus on the ideal number of fragments to be sampled, and current recommendations only aim to improve diagnostic accuracy. This study aimed to evaluate the association between the number of fragments obtained in colposcopic punch biopsy and the recurrence of these lesions. A retrospective, observational, and cross-sectional study was conducted between January 2005 and July 2017, evaluating 127 cases of HSIL surgically treated by excision of the transformation zone. Patients whose punch biopsy sampled 1 or 2 fragments were compared with those whose punch biopsy sampled 3 or more fragments. Sociodemographic data, obstetric history, surgical findings and histopathological characteristics were also analyzed to determine the risk of HSIL recurrence. Punch biopsies with only 1 or 2 fragments were associated with earlier and more frequent recurrences, with a hazard ratio (HR) of 10.229 (95 % CI: 1.315 to 79.583; p = 0.003). A greater number of fragments sampled in colposcopic punch biopsy is associated with a lower risk of HSIL recurrence in the uterine cervix.