Effect of Updated Colposcopy Guidelines for Endocervical Curettage at Time of Colposcopy [ID 2683668

Abstract

INTRODUCTION: The American Society of Colposcopy and Cervical Pathology (ASCCP) guidelines were updated in January 2023 to broaden the use of endocervical curettage (ECC) at the time of colposcopy. We aimed to determine how our practice at a single military institution aligned with the new recommendations. METHODS: After receiving approval from our institutional quality improvement (QI) office, a retrospective chart review was completed for all colposcopies performed at Brooke Army Medical Center from March 1, 2022 to December 31, 2022. Demographic and dysplasia history was extracted for each encounter. Cases were sorted into ASCCP-defined categories of ECC preferred, recommended, acceptable, omission acceptable, and unacceptable. The rate of endocervical curettage completion was compared across each category. RESULTS: Colposcopies were performed in 120 nonpregnant patients. ECC was performed in 95 cases (79%). Based on 2023 guidelines, ECC would be recommended for 57, preferred for 23, acceptable for 25, and omission acceptable for 15. The rates of ECC for recommended (84%) and preferred groups (82.5%) and omission acceptable group (73%) were not significantly different (P=NS). CONCLUSION: Prior to release of the 2023 ASCCP guidelines, ECC at our institution was commonly done in higher-risk groups. To mitigate overall health care burden and unindicated procedures, ECCs should be redistributed away from the omission acceptable groups towards the higher-risk groups. This would lead to an estimated 2.5% increase in overall ECC rate and a 20% increase in high-risk groups. A prospective evaluation of the implication of these guidelines is ongoing.