The effect of directed biopsy on the atypical cervical transformation zone: assessed by digital imaging colposcopy

Objective To determine the effect of directed punch biopsy trauma on the natural history of atypical cervical transformation zones. Design A prospective randomised clinical trial. Setting Academic Unit colposcopy clinics in Birmingham. Participants One hundred and eighty women attending the colposcopy clinics were recruited over an 18 month period, of which 161 were eligible for analysis. Methods Three‐way randomisation of patients into 1. no biopsy, 2. central biopsy and 3. peripheral biopsy groups. Quantitative assessment of the change in surface area and severity of cervical intra‐epithelial neoplasia (CIN) lesions in each group measured six weeks apart using digital imaging colposcopy. Results No significant difference in change in lesion size (P= 0.40) was noted in the three treatment groups. Results suggest that the severity of the lesion was underestimated by the peripheral biopsy. Conclusions The results of this study suggest that directed punch biopsy trauma does not have a significant effect on the immediate natural history of CIN. No statistically significant differences were found in lesion size whether biopsy was employed or not. In addition, the site of biopsy had no influence on the outcome. It appears, therefore, that tissue trauma from punch biopsy and the subsequent inflammatory and wound healing processes do not modify the course of CIN. The regressive changes observed after punch biopsy in previous natural history studies are probably not a result of the initial inflammatory response to biopsy trauma and subsequent re‐epithelialisation with normal cells, but may result from processes that continue long after tissue repair is completed.