Discrepancies in Cervical Biopsy Results: CIN1 vs. CIN2

Cervical biopsy

Previously, an abnormal Pap smear was performed at an obstetrics and gynecology clinic, and the biopsy result was CIN2.
Subsequently, I was referred to a larger hospital for surgery.
However, I decided to have another biopsy for re-evaluation before the surgery, as surgery is a significant procedure.
At another large hospital, I underwent a second biopsy about two weeks after the first one.
The result of the second biopsy showed cellular changes, but it was less than CIN1.
I would like to ask the doctor why there is such a significant difference in the biopsy results.
Which report should be considered more appropriate? Thank you, doctor, for taking the time to answer.

Niming, 20~29 year old female. Ask Date: 2015/09/10

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the biopsy is taken from areas that appear suspicious during the colposcopy examination, so it is possible that the area of concern identified in the first biopsy may have been removed or affected by the first procedure by the time of the second biopsy.
At this point, a more severe report should be used as the basis for determining further treatment.
It is recommended to arrange for a larger biopsy or cone biopsy to confirm whether there are more serious lesions in other areas while also providing treatment.
Thank you! Wishing you peace and health, Dr.
Zhang.

Reply Date: 2015/09/10

More Info

Understanding discrepancies in cervical biopsy results, particularly between CIN1 and CIN2, can be quite perplexing and concerning for patients. The differences in results can arise from several factors, including the sampling technique, the area of the cervix that was biopsied, and the inherent variability in pathological interpretation.

Cervical intraepithelial neoplasia (CIN) is classified into three grades: CIN1, CIN2, and CIN3. CIN1 indicates mild dysplasia, which often resolves on its own without treatment, while CIN2 and CIN3 indicate more severe dysplasia that has a higher risk of progressing to cervical cancer if left untreated. The distinction between these grades is crucial for determining the appropriate management and treatment options.

In your case, the initial biopsy indicated CIN2, which suggests a moderate level of dysplasia. However, upon re-evaluation with a second biopsy, the results showed changes that did not even meet the criteria for CIN1. This discrepancy can be attributed to several factors:
1. Sampling Variability: Biopsies are taken from specific areas of the cervix that appear abnormal during examination. If the second biopsy was taken from a different area, it might not have captured the same abnormal cells that were present in the first biopsy. This is particularly relevant if the first biopsy was taken from a region with more pronounced dysplastic changes.

2. Pathological Interpretation: Different pathologists may interpret the same tissue sample differently. Factors such as the quality of the sample, the staining techniques used, and the pathologist's experience can all influence the diagnosis. It is not uncommon for there to be variations in interpretation, especially in borderline cases.

3. Temporal Changes: The cervix can undergo changes over time due to various factors, including hormonal fluctuations, infections, or even the body's immune response. It is possible that the area that was previously classified as CIN2 may have shown signs of improvement or regression by the time the second biopsy was performed.

Given these factors, it is essential to consider the more severe diagnosis (CIN2) when making decisions about further management. The recommendation would typically be to follow up with a more extensive procedure, such as a large loop excision of the transformation zone (LLETZ) or a cone biopsy, to ensure that any potentially more severe dysplastic changes are adequately addressed. This approach not only helps in confirming the diagnosis but also allows for treatment if necessary.

In conclusion, while the discrepancies in biopsy results can be confusing, they highlight the importance of thorough follow-up and possibly further intervention. Regular monitoring through Pap smears and HPV testing, along with appropriate follow-up biopsies, is crucial in managing cervical health. If you have concerns about your results or the recommended management plan, it is advisable to discuss them with your healthcare provider, who can provide personalized guidance based on your specific situation.

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