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Abstract
The performance of endocervical curettage (ECC) is a dispute in population screening programs. Data of 3,460 women referred to colposcopy examination and had completed pathological results in the Shanxi Province Cervical Cancer Screening Study I and II were reviewed. Among them, 0.6% and 2.7% women were identified as the histopathological confirmed high-grade squamous intraepithelial lesion or worse (HSIL+) by ECC alone or both ECC and quadrants biopsy respectively. Age, cytology, and colposcopy impression are the impact factors for the HSIL+ yield of ECC (P<0.05). The age-adjusted odds ratio for cytology and colposcopic impression were 5.283 (95%CI: 3.989-6.997) and 3.609 (95%CI: 2.910-4.476) respectively. In low-grade squamous intraepithelial lesion cytology and abnormal colposcopy, no additional HSIL+ was found by ECC. In low-grade squamous intraepithelial lesion cytology but normal colposcopy, the additional yield was 0.6%, 0.8% and 1.1% for the three age groups respectively. In high-grade squamous intraepithelial lesion or worse cytology, the additional HSIL+ yield by ECC ranged between 1.4% and 6.6%. We conclude that the performance of ECC increases with age, the severity of cytology, and colposcopic impression. For women 35 years and older, ECC should be performed if the cytological finding is high-grade or worse in cervical cancer screening program.
Highlights
In the recently published cancer statistic in China, the estimated number of new cervical cancer cases among Chinese women is about 8 times of the cases in the U.S [1, 2]
To improve the government implemented cervical cancer screening program, in which 10 million 35-64 years-old women living in rural areas would be screened every year by county level hospitals, more efficient screening procedure, more experienced gynecologists and pathologists are in need
In current guideline of cervical cancer screening, women with abnormal results should be referred to colposcopy, such as human papillomavirus (HPV) positive with atypical squamous cells of undetermined significance (ASC-US) cytology, or lowgrade squamous intraepithelial lesions or worse (LSIL+) cytology alone
Summary
In the recently published cancer statistic in China, the estimated number of new cervical cancer cases among Chinese women is about 8 times of the cases in the U.S [1, 2]. In current guideline of cervical cancer screening, women with abnormal results should be referred to colposcopy, such as human papillomavirus (HPV) positive with atypical squamous cells of undetermined significance (ASC-US) cytology, or lowgrade squamous intraepithelial lesions or worse (LSIL+) cytology alone. The histology diagnosis is the gold standard to define high-grade squamous intraepithelial lesions or carcinomas (HSIL+) cases [3]. It has been reported that random biopsy could increase the HSIL+ yield in women with high-grade cytology [4, 5]. The current guideline [6] prefer endocervical sampling for non-pregnant women with LSIL cytology if the colposcopic examination is inadequate or no lesion is identified; and it is acceptable if the colposcopy is adequate and a lesion is present. Controversy remains of the usefulness of ECC in evaluating women who have abnormal cervical cytology under satisfactory colposcopy. Data from the Shanxi Province Cervical Cancer Screening Study (SPOCCS) I and II during June 1999 to July 2002 were reviewed to estimate the utility of ECC
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