{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T18:02:05Z","timestamp":1793037725905,"version":"4.5.0"},"reference-count":38,"publisher":"Wiley","issue":"13","license":[{"start":{"date-parts":[[2022,5,26]],"date-time":"2022-05-26T00:00:00Z","timestamp":1653523200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007403","name":"Dagmar Marshalls Fond","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007403","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare the proportion of cervical intraepithelial neoplasia grade\u20092 or higher (CIN2+) in cervical biopsies with that in large loop excision of the transformation zone (LLETZ) specimens in women aged \u226545\u2009years with transformation zone type\u20093 (TZ3).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Multicentre cross\u2010sectional study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Three colposcopy clinics in the Central Denmark Region.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Women aged \u226545\u2009years referred to colposcopy as a result of a positive human papillomavirus (HPV) test and\/or abnormal cytology and with TZ3 at colposcopy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Women had multiple biopsies taken and an LLETZ was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Histologically confirmed CIN2+ in biopsies compared with that in LLETZ specimens.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 166 eligible women at colposcopy, 102 women with paired data from biopsies and LLETZ specimens were included for final analysis. The median age was 67.7\u2009years (IQR 62.6\u201370.4\u2009years), and most were postmenopausal (94.1%) and had undergone HPV\u2010based screening (81.3%). The CIN2+ detection rate was significantly higher in LLETZ specimens than in biopsies (32.4% vs 14.7%, difference 17.7%, 95%\u00a0CI 6.3\u201329.0%), resulting in more than half of CIN2+ cases being missed in biopsies (54.5%, 95%\u00a0CI 36.4\u201371.9%). The overall agreement between biopsies and LLETZ was 82.4% (95%\u00a0CI 73.6\u201389.2%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>CIN2+ detection is underestimated in women aged \u226545\u2009years with TZ3 if detection relies on the results of biopsies alone. To reduce the risk of underdiagnosis and overtreatment, future studies should explore the use of new biomarkers for risk stratification to improve discrimination between women at increased risk of CIN2+ who need to undergo LLETZ and women who may undergo follow\u2010up.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17200","type":"journal-article","created":{"date-parts":[[2022,4,30]],"date-time":"2022-04-30T05:16:05Z","timestamp":1651295765000},"page":"2132-2140","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Cervical intraepithelial neoplasia in women with transformation zone type\u00a03: cervical biopsy versus large loop excision"],"prefix":"10.1111","volume":"129","author":[{"given":"Line Winther","family":"Gustafson","sequence":"first","affiliation":[{"name":"Department of Public Health Programmes, Randers Regional Hospital University Research Clinic for Cancer Screening  Randers Denmark"},{"name":"Department of Clinical Medicine Aarhus University  Herning Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4616-9827","authenticated-orcid":false,"given":"Anne","family":"Hammer","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine Aarhus University  Herning Denmark"},{"name":"Department of Obstetrics and Gynaecology G\u00f8dstrup Hospital  Herning Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Holten","family":"Bennetsen","sequence":"additional","affiliation":[{"name":"Department of Pathology Randers Regional Hospital  Randers Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina\u00a0Blach","family":"Kristensen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Horsens Regional Hospital  Horsens Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huda","family":"Majeed","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Viborg Regional Hospital  Viborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lone Kjeld","family":"Petersen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Odense University Hospital  Odense Denmark"},{"name":"Open Patient data Explorative Network, Department of Clinical Research University of Southern Denmark  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berit","family":"Andersen","sequence":"additional","affiliation":[{"name":"Department of Public Health Programmes, Randers Regional Hospital University Research Clinic for Cancer Screening  Randers Denmark"},{"name":"Department of Clinical Medicine Aarhus University  Herning Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pinar","family":"Bor","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine Aarhus University  Herning Denmark"},{"name":"Department of Obstetrics and Gynaecology Randers Regional Hospital  Randers Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,5,26]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(19)30482-6"},{"key":"e_1_2_8_3_1","unstructured":"DanckertB FerlayJ EngholmG HansenHL JohannesenTB KhanS K\u00f8tlumJE \u00d3lafsd\u00f3ttirE SchmidtLKH VirtanenAandStormHH.NORDCAN: Cancer Incidence Mortality Prevalence and Survival in the Nordic Countries Version 8.2 (26.03.2019). Association of the Nordic Cancer Registries. Danish Cancer Society. 2021 13\/09\/2021. Available from:http:\/\/www.ancr.nu."},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13057"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13608"},{"issue":"9","key":"e_1_2_8_6_1","first-page":"5147","article-title":"Elderly women above screening age diagnosed with cervical cancer have a worse prognosis","volume":"34","author":"Darlin L","year":"2014","journal-title":"Anticancer Res"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.55.9948"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0b013e3181fb4547"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13832"},{"key":"e_1_2_8_10_1","unstructured":"PetersenLK SchrollJ DollerisBB BundgaardA KirschnerB BoothBB et al.National clinical guideline for cervical dysplasia. Examination treatment and management of women aged 60 and older [Only in Danish]: DSOG 2019. Available from:https:\/\/www.sst.dk\/\u2010\/media\/Opgaver\/Patientforl%C3%B8b\u2010og\u2010kvalitet\/NKR\/Puljefinansierede\u2010NKR\/pdf\u2010version\u2010af\u2010ublished_guideline_2633.ashx?la=da&hash=0809DD9A773B341B3D08AE73C9361E2AB84029E8"},{"key":"e_1_2_8_11_1","unstructured":"Gynecology SSoOa.SFOG\u2010riktlinje av NVP f\u00f6r cervixcancerprevention 2019 [updated Uppdaterad 190330.; SFOG\u2010riktlinje av Nationellt v\u00e5rdprogram livmoderhalscancerprevention (NVP) f\u00f6r cervixcancerprevention.[Only in Swedish]]. Available from:https:\/\/www.sfog.se\/media\/336482\/sfog\u2010riktlinje\u2010190330_revhs\u2010190413.pdf."},{"key":"e_1_2_8_12_1","unstructured":"FrazerI.Guidelines for the management of screen\u2010detected abnormalities screening in specific populations and investigation of abnormal vaginal bleeding.: cancer council Australia cervical cancer screening guidelines working party.2020National Cervical Screening Program Sydney: Cancer Council Australia; [cited 2020 October 30]. Available from:https:\/\/wiki.cancer.org.au\/australia\/Guidelines:Cervical_cancer\/Screening."},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0000000000000525"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0000000000000287"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10147-017-1124-z"},{"key":"e_1_2_8_16_1","unstructured":"NSLS.The National Steering Committee for Cervical Cancer Screening 2021. Available from:https:\/\/www.regioner.dk\/nsls\/viden"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-039636"},{"key":"e_1_2_8_18_1","unstructured":"Colposcopy TIFoCPa.IFCPC Nomenclature. Available from:https:\/\/ifcpc.org\/medical\u2010professionals\/ifcpc\u2010nomenclature\/"},{"key":"e_1_2_8_19_1","unstructured":"PetersenL.Cervix dysplasia \u2010 Guideline: Danish Society of Obstetrics and Gynecology;2012. Available from:https:\/\/www.dsog.dk\/gynkologi"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S9908"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-11074-5"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.05552-11"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003081-196712000-00002"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0246902"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0217108"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.09.039"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurox.2019.100042"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10552-020-01278-0"},{"issue":"7","key":"e_1_2_8_31_1","first-page":"QC18","article-title":"Comparison of vaginal versus Oral estradiol Administration in Improving the visualization of transformation zone (TZ) during colposcopy","volume":"10","author":"Beniwal S","year":"2016","journal-title":"J Clin Diagn Res"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1159\/000358391"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.12545"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.06.048"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000270154.69879.09"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S259095"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djv257"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2019.0306"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.33320"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.17200","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1471-0528.17200","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.17200","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T05:39:44Z","timestamp":1692596384000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/1471-0528.17200"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,26]]},"references-count":38,"journal-issue":{"issue":"13","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10.1111\/1471-0528.17200"],"URL":"https:\/\/doi.org\/10.1111\/1471-0528.17200","archive":["Portico"],"relation":{},"ISSN":["1470-0328","1471-0528"],"issn-type":[{"value":"1470-0328","type":"print"},{"value":"1471-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,26]]},"assertion":[{"value":"2021-11-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-03-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-05-26","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}