Indications for colposcopy-guided cervical biopsy Key points: cervical biopsy must be taken whenever invasive cervical cancer or HSIL is suspected. (1) For satisfactory colposcopic findings and suspicion of CIN2,3 or cervical invasive carcinoma: it is advisable to take biopsies at multiple points in the most severely lesioned area. If the colposcopist is inexperienced, it is advisable to select four points within the transformation zone and at the neo-squamous junction 3, 6, 9 and 12. (2) In case of unsatisfactory colposcopic findings and suspicion of CIN2,3 or cervical invasive carcinoma: in addition to multi-point biopsy at the most severe lesion in the ectocervix, endocervical canal scraping (ECC) should be performed. If there is no contraindication to cervical conization, diagnostic cervical conization by LEEP can be directly selected. (3) Cervical cytology results of ASC-H, HSIL, AGC, even if colposcopy does not reveal any abnormality, cervical biopsy must be taken, which includes the following two cases: ① satisfactory colposcopic results: select the zone of transformation, new squamocolumnar junction 3, 6, 9, 12 four points to take the material. ② Unsatisfactory colposcopic findings: when there are no contraindications to cervical conization, LEEP can be directly selected for diagnostic cervical conization. ECC can also be performed. (4) For postmenopausal women: the estrogen level in postmenopausal women decreases, the cervical squamous-columnar junction mostly moves up into the cervical canal, and the colposcopic findings are mostly unsatisfactory. For their colposcopy and cervical biopsy, referral to a clinically experienced physician is appropriate. For accurate assessment of lesions in the cervical canal, the indications for diagnostic cervical conization can be moderately relaxed.