Journal List > J Gynecol Oncol > v.29(4) > 1099253

Wetcho, Rattanaburi, and Kanjanapradit: Quality of tissue from punch biopsy forceps vs. round loop electrode in colposcopically directed biopsy: a randomized controlled trial

Abstract

Objective

To compare the quality of tissue from punch biopsy forceps (PB group) with round loop electrode (LE group) in colposcopically directed biopsy along with the evaluation of pain associated with each procedure.

Methods

Patients with abnormal cervical cytologic results and abnormal colposcopic findings were enrolled into a randomized trial into either a PB group or LE group. The quality of tissue was evaluated in regards to the size of tissue, site of tissue, and tissue damage. Each quality had 1 to 3 points and the sum of each quality contributed to the total tissue score that ranged from 3 to 9. Pain associated with each procedure was assessed by a visual analog scale (VAS). This was a clinical trial study and was registered at www.clinicaltrials.in.th (Identifier: TCTR20160404001).

Results

Ninety-six women who met all eligibility requirements were enrolled in the study. Forty-eight patients were randomly assigned to the PB group and 48 patients were randomized into the LE group. The characteristics of the patients were similar between the 2 groups with the exception of the median age. The median total tissue score was 8 points in the LE group which was more than the median of 7 points in the PB group with a statistically significant difference (p=0.014). However, the median VAS pain score in both groups was 3.4 (p=0.82).

Conclusion

The quality of cervical tissues obtained from biopsy with a round loop electrode was better than the punch biopsy forceps with no difference in the level of pain.

References

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Fig. 1.
Diagnostic equipment for cervical biopsy: Kevorkian biopsy forceps (upper) and the round loop electrode (lower).
jgo-29-e52f1.tif
Fig. 2.
Flow of patients through the study. LE group, round loop electrode group; PB group, punch biopsy forceps group.
jgo-29-e52f2.tif
Table 1.
Quality of tissue scores
Quality of tissue Scores (points)
1 2 3
1. Size of tissue Tissue area is less than 5 mm2. Tissue area is between 5–10 mm2. Tissue area is more than 10 mm2.
2. Site of tissue There is neither epithelial nor stromal tissue. There is either epithelial or stromal tissue. There are both epithelial and stromal tissue.
3. Tissue damage There is either distortion or electrocautery effect that cannot evaluate pathologic result. There is either distortion or electrocautery effect but can evaluate pathologic result. There is neither distortion nor electrocautery effect.
Table 2.
Patient characteristics
Characteristics PB group (n=48) LE group (n=48) p-value
Age (yr) 38.9 (10.2) 44.8 (12.2) 0.011*
Reproductive status     0.190
 Premenopause 42 (87.5) 36 (75)  
 Menopause 6 (12.5) 12 (25)  
Parity     0.350
 Nulliparous 15 (31.2) 10 (20.8)  
 Multiparous 33 (68.8) 38 (79.2)  
History of pills used     0.520
 Yes 15 (31.2) 19 (39.6)  
 No 33 (68.8) 29 (60.4)  
History of chronic pelvic pain/dysmenorrhea     1.000
 Yes 21 (43.8) 21 (43.8)  
 No 27 (56.2) 27 (56.2)  
Previous sexually transmitted disease     0.490
 Yes 3 (6.2) 6 (12.5)  
 No 45 (93.8) 42 (87.5)  
Smoking     1.000
 Yes 1 (2.1) 0 (0)  
 No 47 (97.9) 48 (100)  
Cytology report     0.720
 ASC-US 17 (35.4) 15 (31.2)  
 ASC-H 9 (18.8) 8 (16.7)  
 LSIL 17 (35.4) 16 (33.3)  
 HSIL 5 (10.4) 9 (18.8)  
HPV status     0.740
 Unknown 26 (54.2) 27 (56.2)  
 HPV 16 or 18 positive 14 (29.2) 11 (22.9)  
 HPV 16 and 18 negative 8 (16.7) 10 (20.8)  
Colposcopic assessment     0.240
 Adequate 39 (81.2) 33 (68.8)  
 Inadequate 9 (18.8) 15 (31.2)  
Reid colposcopic index score     0.790
 0–2 6 (12.5) 8 (16.7)  
 3–5 33 (68.8) 30 (62.5)  
 6–8 9 (18.8) 10 (20.8)  
Histological report     0.730
 No dysplasia, koilocytosis 30 (62.5) 28 (58.3)  
 CIN1 6 (12.5) 4 (8.3)  
 CIN2 1 (2.1) 3 (6.2)  
 CIN3/CIS 11 (22.9) 13 (27.1)  
Post-operative complication     1.000
 Yes 1 (2.1) 1 (2.1)  
 No 47 (97.9) 47 (97.9)  
Further management     0.250
 Yes 12 (25) 16 (33.3)  
 No 36 (75) 32 (66.7)  

Values are presented as mean (SD) or number (%).

ASC-H, atypical squamous cells cannot rule out high-grade squamous intraepithelial lesion; ASC-US, atypical squamous cells of undetermined significance; CIN, cervical intraepithelial neoplasia; CIS, carcinoma in situ; HPV, human papillomavirus; HSIL, high-grade-squamous intraepithelial lesion; LE group, round loop electrode group; LSIL, low-grade squamous intraepithelial lesion; PB group, punch biopsy forceps group; SD, standard deviation.

* Student's t-test;

χ2 test;

Fisher's exact test.

Table 3.
Comparison of tissue scores
Characteristics PB group (n=48) LE group (n=48) p-value
Total tissue scores (median) 7 8 0.014*
Size of tissue     <0.001
 1 20 (41.7) 5 (10.4)  
 2 16 (33.3) 17 (35.4)  
 3 12 (25) 26 (54.2)  
Site of tissue     0.240
 1 0 (0) 0 (0)  
 2 3 (6.2) 0 (0)  
 3 45 (93.8) 48 (100)  
Tissue damage     0.003
 1 0 (0) 0 (0)  
 2 36 (75) 47 (97.9)  
 3 12 (25) 1 (2.1)  

Values are presented as number (%). LE group, round loop electrode group; PB group, punch biopsy forceps group.

* Wilcoxon rank sum test;

χ2 test;

Fisher's exact test.

Table 4.
Comparison of VAS pain scores
Comparisons PB group (n=48) LE group (n=48) p-value*
VAS pain score (median) 3.4 3.4 0.820

LE group, round loop electrode group; PB group, punch biopsy forceps group; VAS, visual analog scale.

* Wilcoxon rank sum test.

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