Diagnostic accuracy of colposcopy-directed biopsy compared with LEEP histology: A retrospective cohort study
In brief
Colposcopy biopsy detected 97% of CIN2+ lesions but often overestimated severity
Among 423 procedures later followed by LEEP, colposcopy-directed biopsy had 97% sensitivity but only 20% specificity for CIN2+, and biopsy and LEEP findings matched exactly in 61.7% of cases. Overestimation was more common than underestimation; agreement was lower with type 3 transformation zones and after menopause, underscoring the need to interpret biopsy results in clinical context.
- Journal
- Cancer treatment and research communications (Q2)
- Published
- 19 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Katharina Kowoll, Jens Hachenberg, Jan Lennart Stalp, Peter Hillemanns, Lars Brodowski, Lena Steinkasserer
- PMID
- 42896410
- DOI
- 10.1016/j.ctarc.2026.101492
Why clinicians should know about it
- Picked for Pathology and Forensic Medicine (top studies of the week, 25 October 2026): Measures biopsy accuracy, histologic agreement, and diagnostic underestimation
Abstract
BACKGROUND: Colposcopy-directed biopsy is widely used in the diagnosis of cervical dysplasia, but its accuracy is variable. Reliable detection of clinically significant lesions (CIN2+) is essential for appropriate treatment. This study assessed its diagnostic performance using histology after LEEP as the reference standard and explored factors associated with discrepancies. METHODS: 423 procedures were analyzed. Histological findings from colposcopy-directed biopsy were compared with the histology of the subsequent LEEP specimen. Diagnostic performance for CIN2+ was evaluated using sensitivity, specificity, predictive values, and accuracy; agreement was assessed using weighted Cohen's kappa. Subgroup analyses considered transformation zone (TZ) type, age, and menopausal status. Multivariable logistic regression assessed predictors of histopathological underestimation. RESULTS: Biopsy showed 97.0% sensitivity, 20.0% specificity, and 80.6% accuracy for CIN2+ detection. Exact histological agreement occured in 61.7% of procedures (κ = 0.31). Histopathological underestimation occurred in 12.3% and overestimation in 26.0%, indicating a tendency toward overestimation. Exact agreement decreased from 75.8% in TZ1 to 48.0% in TZ3 and from 65.2% in premenopausal to 48.4% in postmenopausal patients. Complete-case multivariable analysis included 227 procedures and 23 underestimation events. Compared with TZ1, TZ2 and TZ3 were independently associated with higher odds of underestimation other included covariates were not. CONCLUSION: Colposcopy-directed biopsy shows high sensitivity but limited specificity for CIN2+ detection, with notable diagnostic discrepancies. Histological concordance was lower in patients with TZ 3 and in postmenopausal women, while TZ was independently associated with underestimation. These findings highlight the importance of considering anatomical and patient-related factors when interpreting biopsy results and planning clinical management.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.