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S Ciatto - One of the best experts on this subject based on the ideXlab platform.
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loop electrosurgical excision procedure of the transformation zone and colposcopically directed Punch Biopsy in the diagnosis of cervical lesions
Obstetrics & Gynecology, 1992Co-Authors: R Bonardi, Silvia Cecchini, G Grazzini, S CiattoAbstract:OBJECTIVE To estimate the disagreement between the histologic reports at colposcopically directed Punch Biopsy of the cervix and subsequent loop excision of the transformation zone, and to assess the indications for loop excision in current practice. METHODS The histologic diagnoses from loop electrosurgical excision procedures and concurrent colposcopically directed Punch biopsies were compared in 337 consecutive women undergoing loop excision in a 5-year period. RESULTS Disagreement between Punch Biopsy and loop excision was recorded in 190 cases (56.4%). The undercall and overcall rates for Punch Biopsy were 14 and 42.4%, respectively. Undercall at Punch Biopsy occurred in 24 of 46 cases of cervical intraepithelial neoplasia (CIN) III and in one microinvasive cancer diagnosed at loop excision, and disagreement was within one grade of CIN in 16 cases. CONCLUSIONS Loop electrosurgical excision allows further and more accurate histologic examination of the transformation zone and should be the standard assessment procedure in all cases of CIN II detected at Punch Biopsy and whenever cytology or colposcopy suggests the risk of Punch Biopsy undercall. Immediate treatment by local destruction should not be performed, to avoid underestimation of the severity of the lesion.
Nicole W J Kellenerssmeets - One of the best experts on this subject based on the ideXlab platform.
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correlation between histological findings on Punch Biopsy specimens and subsequent excision specimens in cutaneous squamous cell carcinoma
Acta Dermato-venereologica, 2015Co-Authors: A Westersattema, M H Roozeboom, Patty J Nelemans, Arienne M W Van Marion, Bjorn G P M Lohman, Peter M Steijlen, V M H J Joosten, A A Botterweck, Nicole W J KellenerssmeetsAbstract:Diagnosis and subsequent treatment of cutaneous squamous cell carcinoma are frequently based on Punch biopsies. Regarding the current TNM classification and stage grouping for cutaneous squamous cell carcinoma, it is important to identify the high-risk features (infiltration depth >4 mm, perineural and/or lymphovascular invasion and poor differentiation). This study investigates the agreement of histological high-risk features and TNM grouping stage on 3 mm Punch biopsies and subsequent surgical excision in 105 patients diagnosed with cutaneous squamous cell carcinoma. On Punch Biopsy, infiltration depth >4 mm is not identified in 83.3% (30/36), perineural invasion in 90.9% (10/11) and poor differentiation in 85.7% (6/7) of cases. The TNM stage was underestimated on Punch Biopsy in 15.4% (16/104). This study shows that on a 3-mm Punch Biopsy, high-risk features in cutaneous squamous cell carcinoma can remain undetected and that the actual TNM stage is not identified in 1 out of 6 tumours.
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agreement between histological subtype on Punch Biopsy and surgical excision in primary basal cell carcinoma
Journal of The European Academy of Dermatology and Venereology, 2013Co-Authors: M H Roozeboom, Klara Mosterd, Veronique Winnepenninckx, Patty J Nelemans, Nicole W J KellenerssmeetsAbstract:Background Diagnosis of clinically suspected basal cell carcinoma (BCC) by histological confirmation with Punch Biopsy has been recommended before treatment. Even shave Biopsy has been proposed as useful to predict the correct subtype in primary BCC in 76–81%, whereas the agreement between histological BCC subtype on Punch Biopsy and subsequent excision specimens in recurrent BCC is 67.1%. However, no large studies on the agreement between histological BCC subtype seen on Punch Biopsy and the following surgical excision are performed in primary BCC. Objective The aims of this study were (i) to establish the agreement between histological BCC subtype on Punch Biopsy and the subsequent surgical excision of primary BCC and; (ii) to investigate the proportion of primary BCCs in which Punch Biopsy enables identification of the most aggressive growth pattern. Methods Retrospective analyses of 243 primary BCCs with both Punch Biopsy and subsequent surgical excision. Analyses were based on the most aggressive histological subtype of the tumour. Results The agreement between BCC subtype on Punch Biopsy and the subsequent surgical excision of primary BCCs was 60.9%. A Punch Biopsy can predict the most aggressive growth pattern of primary BCCs in 84.4%. Seventy-four percentage of all primary BCCs consisted of more than one histological subtype. Conclusion Dermatologists and other physicians have to be aware of the limited diagnostic value of a Punch Biopsy to determine the histological BCC subtype of the whole lesion. Misdiagnosis of the subtype will lead to undertreatment in one of six primary BCCs.
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correlation between histologic findings on Punch Biopsy specimens and subsequent excision specimens in recurrent basal cell carcinoma
Journal of The American Academy of Dermatology, 2011Co-Authors: Klara Mosterd, Patty J Nelemans, Monique R T M Thissen, Arienne M W Van Marion, Bjorn G P M Lohman, Peter M Steijlen, Nicole W J KellenerssmeetsAbstract:Background The type of treatment for a basal cell carcinoma (BCC) depends on the histologic subtype. Histologic examination is usually performed on incisional Biopsy specimens. In primary BCC, the histologic subtype is correctly identified with a Punch Biopsy in 80.7% of cases. In recurrent BCC, correct identification is more difficult because of discontinuous growth caused by scar formation. Because an aggressive histologic subtype has a significantly higher risk for recurrence in these tumors, the histologic subtype is at least as important in recurrent BCC as it is in primary BCC. Objective To investigate the correlation between histologic findings on Punch Biopsy specimens and subsequent excision specimens in recurrent BCC. Furthermore, we sought to clarify how often an aggressive histologic subtype was missed, based on the Punch Biopsy specimen. Methods We compared the histologic subtype in a Punch Biopsy specimen with the subsequent excision specimen in recurrent BCC. All BCCs were coded and judged randomly by the same dermatopathologist. Results In 24 of 73 investigated BCCs (32.9%), the histologic subtype of the initial Biopsy did not match with the histologic subtype of the subsequent excision. Of the 37 excised BCCs with an aggressive histologic subtype, 7 (19%) were missed by the initial Punch Biopsy. Limitations Intraobserver variation may have affected the results of this study. Conclusions Discriminating tumors with any aggressive growth is relevant for treatment. However, in recurrent BCC, the histology of the Biopsy specimen does not always correlate with the histology of the definitive excision. This may have important therapeutic implications.
Esther L Moss - One of the best experts on this subject based on the ideXlab platform.
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the use of the colposcopically directed Punch Biopsy in clinical practice a survey of british society of colposcopy and cervical pathology bsccp accredited colposcopists
Journal of Lower Genital Tract Disease, 2016Co-Authors: Eva Myriokefalitaki, C W E Redman, Neelam Potdar, Philippa Pearmain, Esther L MossAbstract:ObjectivesThe colposcopically directed Punch Biopsy has been an integral component of colposcopic practice. In light of the changing landscape of the cervical screening programme, a study was conducted to investigate the current practice of British Society of Colposcopy and Cervical Pathology–accred
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is the colposcopically directed Punch Biopsy a reliable diagnostic test in women with minor cytological lesions
Journal of Lower Genital Tract Disease, 2012Co-Authors: Esther L Moss, Paula Hadden, G Douce, P W Jones, Marc Arbyn, Charles W E RedmanAbstract:OBJECTIVE The study aimed to determine the accuracy of the colposcopy-directed Punch Biopsy (Punch) to detect or exclude high-grade cervical intraepithelial neoplasia (CIN 2 or 3) in women with atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL) cytological result and minor colposcopic findings. MATERIALS AND METHODS In a diagnostic test accuracy study, women with ASCUS or LSIL cytological result and minor colposcopic changes had a single colposcopy-targeted Punch Biopsy was performed immediately followed by a loop electrocautery excision procedure (LEEP) Biopsy. The trial was powered to detect a level of κ for a dichotomous outcome of 0.4 (i.e., fair-to-moderate agreement), with a two-sided significance level of 5% and a power of 90%. Accuracy parameters were computed using a cutoff for positive Punch Biopsy result of CIN 1+ and CIN 2+ for an outcome of CIN 2+ and CIN 3+ assessed in the LEEP specimen. RESULTS Sixty-eight Punch Biopsy/LEEP-paired samples were analyzed. Of the 8 CIN 3 lesions, 6 and 4 were detected at cutoff CIN 1+ and CIN 2+, respectively (sensitivity, 50% and 75%). The corresponding specificities were 65% (39/60) and 97% (58/60). The Punch biopsies identified only 14 (67%) or 6 (20%) of the 21 CIN 2+ lesions at cutoff CIN 1+ or CIN 2+, respectively. Of the Punch biopsies, 31 (45.6%) accurately detected the severity of cervical abnormality. CONCLUSIONS A single colposcopically directed Punch Biopsy appears to be insufficient to exclude underlying CIN 2 or 3.
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accuracy of colposcopy directed Punch biopsies a systematic review and meta analysis
British Journal of Obstetrics and Gynaecology, 2012Co-Authors: Martyn Underwood, Marc Arbyn, C W E Redman, William Parrysmith, S De Bellisayres, R W Todd, Esther L MossAbstract:Please cite this paper as: Underwood M, Arbyn M, Parry-Smith W, De Bellis-Ayres S, Todd R, Redman CWE, Moss EL. Accuracy of colposcopy-directed Punch biopsies: a systematic review and meta-analysis. BJOG 2012;119:1293–1301. Background The colposcopy-directed Punch Biopsy is widely used in the management of women with abnormal cervical cytology; however, its accuracy compared with definitive histology from an excision Biopsy is not well established. Objectives To assess the accuracy of the colposcopy-directed Punch Biopsy to diagnose high-grade cervical intraepithelial neoplasia (CIN) by performing a systematic review and meta-analysis. Search strategy A systematic search of MEDLINE, EMBASE and the Cochrane Library was performed. Selection criteria Articles that compared the colposcopically directed cervical Punch Biopsy with definitive histology from an excisional cervical Biopsy or hysterectomy. Data collection and analysis Random effects and hierarchical summary receiver operating characteristic regression models were used to compute the pooled sensitivity and specificity applying different test cut-offs for outcomes of high-grade CIN. Main results Thirty-two papers comprising 7873 paired Punch/definitive histology results were identified. The pooled sensitivity for a Punch Biopsy defined as test cut-off CIN1+ to diagnose CIN2+ disease was 91.3% (95% CI 85.3–94.9%) and the specificity was 24.6% (95% CI 16.0–35.9%). In most of the studies, the majority of enrolled women had positive Punch biopsies. Pooling of the four studies where the excision Biopsy was performed immediately after the Punch Biopsy, and where the rate of positive Punch biopsies was considerably lower, yielded a sensitivity of 81.4% and specificity of 63.3%. Author’s conclusion The observed high sensitivity of the Punch Biopsy derived from all studies is probably the result of verification bias.
R Bonardi - One of the best experts on this subject based on the ideXlab platform.
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loop electrosurgical excision procedure of the transformation zone and colposcopically directed Punch Biopsy in the diagnosis of cervical lesions
Obstetrics & Gynecology, 1992Co-Authors: R Bonardi, Silvia Cecchini, G Grazzini, S CiattoAbstract:OBJECTIVE To estimate the disagreement between the histologic reports at colposcopically directed Punch Biopsy of the cervix and subsequent loop excision of the transformation zone, and to assess the indications for loop excision in current practice. METHODS The histologic diagnoses from loop electrosurgical excision procedures and concurrent colposcopically directed Punch biopsies were compared in 337 consecutive women undergoing loop excision in a 5-year period. RESULTS Disagreement between Punch Biopsy and loop excision was recorded in 190 cases (56.4%). The undercall and overcall rates for Punch Biopsy were 14 and 42.4%, respectively. Undercall at Punch Biopsy occurred in 24 of 46 cases of cervical intraepithelial neoplasia (CIN) III and in one microinvasive cancer diagnosed at loop excision, and disagreement was within one grade of CIN in 16 cases. CONCLUSIONS Loop electrosurgical excision allows further and more accurate histologic examination of the transformation zone and should be the standard assessment procedure in all cases of CIN II detected at Punch Biopsy and whenever cytology or colposcopy suggests the risk of Punch Biopsy undercall. Immediate treatment by local destruction should not be performed, to avoid underestimation of the severity of the lesion.
M A De Rie - One of the best experts on this subject based on the ideXlab platform.
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diagnostic accuracy of confocal microscopy imaging vs Punch Biopsy for diagnosing and subtyping basal cell carcinoma
Journal of The European Academy of Dermatology and Venereology, 2017Co-Authors: D J Kadouch, A C Van Der Wal, A Wolkerstorfer, M W Bekkenk, Mariska M G Leeflang, Y S Elshot, Caterina Longo, M Ulrich, M A De RieAbstract:BackgroundIn vivo reflectance confocal microscopy (RCM) is a promising non-invasive skin imaging technique that could facilitate early diagnosis of basal cell carcinoma (BCC) instead of routine Punch biopsies. However, the clinical value and utility of RCM vs. a Punch Biopsy in diagnosing and subtyping BCC is unknown. ObjectiveTo assess diagnostic accuracy of RCM vs. Punch Biopsy for diagnosing and subtyping clinically suspected primary BCC. MethodsA prospective, consecutive cohort of 100 patients with clinically suspected BCC were included at two tertiary hospitals in Amsterdam, the Netherlands, between 3 February 2015 and 2 October 2015. Patients were randomized between two test-treatment pathways: diagnosing and subtyping using RCM imaging followed by direct surgical excision (RCM one-stop-shop) or planned excision based upon the histological diagnosis and subtype of Punch Biopsy (standard care). The primary outcome was the agreement between the index tests (RCM vs. Punch Biopsy) and reference standard (excision specimen) in correctly diagnosing BCC. The secondary outcome was the agreement between the index tests and reference standard in correctly identifying the most aggressive BCC subtypes. ResultsSensitivity to detect BCC was similar for RCM and Punch Biopsy (100% vs. 93.94%), but a Punch Biopsy was more specific than RCM (79% vs. 38%). RCM expert evaluation for diagnosing BCC had a sensitivity of 100% and a specificity of 75%. The agreement between RCM and excision specimen in identifying the most aggressive BCC subtype ranged from 50% to 85% vs. 77% by a Punch Biopsy. ConclusionReflectance confocal microscopy and Punch Biopsy have comparable diagnostic accuracy to diagnose and subtype BCC depending on RCM experience. Although experienced RCM users could accurately diagnose BCC at a distance, we found an important difference in subtyping BCC. Future RCM studies need to focus on diagnostic accuracy, reliability and specific criteria to improve BCC subtype differentiation
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diagnostic accuracy of confocal microscopy imaging vs Punch Biopsy for diagnosing and subtyping basal cell carcinoma
Journal of The European Academy of Dermatology and Venereology, 2017Co-Authors: D J Kadouch, A C Van Der Wal, A Wolkerstorfer, M W Bekkenk, Mariska M G Leeflang, Y S Elshot, Caterina Longo, M Ulrich, M A De RieAbstract:Background In vivo reflectance confocal microscopy (RCM) is a promising non-invasive skin imaging technique that could facilitate early diagnosis of basal cell carcinoma (BCC) instead of routine Punch biopsies. However, the clinical value and utility of RCM versus a Punch Biopsy in diagnosing and subtyping BCC is unknown. Objective To assess diagnostic accuracy of RCM versus Punch Biopsy for diagnosing and subtyping clinically suspected primary BCC. Methods A prospective, consecutive cohort of 100 patients with clinically suspected BCC were included at two tertiary hospitals in Amsterdam, the Netherlands, between February 3, 2015 and October 2, 2015. Patients were randomized between two test-treatment pathways: diagnosing and subtyping using RCM imaging followed by direct surgical excision (RCM one-stop-shop) or planned excision based upon the histological diagnosis and subtype of Punch Biopsy (standard care). The primary outcome was the agreement between the index tests (RCM versus Punch Biopsy) and reference standard (excision specimen) in correctly diagnosing BCC. The secondary outcome the agreement between the index tests and reference standard in correctly identifying the most aggressive BCC subtypes. Results Sensitivity to detect BCC was similar for RCM and Punch Biopsy (100% versus 93.94%), but a Punch Biopsy was more specific than RCM (79% versus 38%). RCM expert evaluation for diagnosing BCC had a sensitivity of 100% and a specificity of 75%. The agreement between RCM and excision specimen in identifying the most aggressive BCC subtype ranged from 50% to 85% versus 77% by a Punch Biopsy. Conclusion RCM and Punch Biopsy have comparable diagnostic accuracy to diagnose and subtype BCC depending on RCM experience. Although experienced RCM users could accurately diagnose BCC at a distance, we found an important difference in subtyping BCC. Future RCM studies need to focus on diagnostic accuracy, reliability and specific criteria to improve BCC subtype differentiation. This article is protected by copyright. All rights reserved.
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is a Punch Biopsy reliable in subtyping basal cell carcinoma a systematic review
British Journal of Dermatology, 2016Co-Authors: D J Kadouch, J Limpens, A C Van Der Wal, A Wolkerstorfer, M W Bekkenk, M A De RieAbstract:Basal cell carcinoma (BCC) is the most prevalent type of skin cancer. Numerous studies have reported on the rising incidence of BCC causing a major burden on current health care systems (1) . Current management relies on the histopathological subtype of a Punch Biopsy and this becomes more and more relevant due to the increasing use of non-surgical treatments. However the reliability of a Punch Biopsy in subtyping BCC has been questioned. The aim of this systematic review was to judge the reliability of a Punch Biopsy in accurately subtyping primary BCC. This article is protected by copyright. All rights reserved
