Relevance of random biopsy at the transformation zone when colposcopy is negative

As recommended by European Guidelines, the key for improving the standard of care for patients with cervical intraepithelial lesions is the skill of the colposcopist, who also has the responsibility of facilitating shared decision-making through patient information before, during, and after the examination. Recently, it has been reported that, if colposcopic examination results are normal, women with low-grade cervical cytology, even with a positive HPV test, can return to routine recall; this is surely an advantage from both a psychological and economic point of view. Our suggestion for improving the detection of high rate disease is to use a low threshold of abnormality at colposcopy (any acetowhitening); this also will favor better training for the colposcopist, rather than adding nondirected biopsies.