Colposcopic multi-point biopsy for cervical precancerous lesions, an observational study published in JCO. Patients with abnormal cervical cancer screening results usually undergo colposcopy and biopsy to diagnose cervical precancerous lesions (highly squamous epithelial lesions, HSIL). Colposcopic single-site biopsies tend to miss HSIL lesions. However, there are no systematic studies to confirm that lesion-guided multipoint biopsy improves the detection rate of HSIL. Thus, in the Biopsy Study, 690 patients with abnormal cervical cancer screening underwent colposcopy. Up to 4 biopsies were taken for lesions with significant vinegar white (+) and ranked according to colposcopic impression. If there were less than 4 total biopsy sites, random biopsies of normal sites were added. Results In all populations, the detection rate of HSIL increased with increasing biopsy site: single site biopsy, 60.6%; two sites, 85.6%; and three or more sites, 95.6%. The sensitivity of detection increased with increasing biopsy site in each subgroup of different screening results. HSIL detection was highest in the following conditions: colposcopic suspicion of high-grade lesions, cytological HSIL, HPV16 positivity, etc. Of all participants diagnosed with HSIL, only 2% were detected by a normal-appearing biopsy of the cervical migration zone. Therefore, the authors concluded that the addition of additional lesion-guided biopsy sites during colposcopy could increase the detection rate of histologic HSIL, regardless of the patient’s characteristics. Performing additional biopsies when multiple lesions are present should become a standard practice for colposcopic biopsy.