Endocervical Curettage in Cervical Evaluation

Abstract

To investigate the role of endocervical curettage (ECC) in the evaluation of cervical dysplasia, the authors analyzed information from a database listing 581 patients with cervical abnormality. All patients had control spatula and cytobrush smears and underwent colposcopic examination with ECC. In patients with acetowhite epithelium, biopsy samples were obtained from the most suspicious areas before ECC was performed. A low-grade lesion was diagnosed in the cervical smears of 40.5 percent of the patients studied. ECC results were negative in 104 of these 115 (92 percent) patients with stage 1 cervical intraepithelial neoplasia (CIN1) and positive for low-grade squamous intraepithelial lesions (LSILs) in only 8 women (9 percent). One patient had a cervical smear indicating LSIL and ECC results indicating CIN2–3. Among the 70 patients with a smear showing high-grade squamous intraepithelial lesions (HSILs), 56 (80 percent) had negative ECC results. ECC also showed CIN2–3 in 20 percent. There were no patients with CIN1 on their ECC if the cervical smear at the time of colposcopic examination was negative (98 patients). Only 9 percent had ECC results showing CIN1, and none had a more severe diagnosis. ECC results were similar in patients with and without satisfactory colposcopy results. There was no association of positive ECC results with acetowhite grade II epithelium. Colposcopically directed exocervical biopsy showed CIN1 in 53 percent of patients. The ECC results were negative in 88 percent of these women and showed CIN1 in 9 percent and CIN2–3 in 3 percent. Among the 85 patients with CIN2–3 diagnosed by biopsy, the ECC specimen was negative in 81 percent, CIN1 was found in 5 percent, and CIN2–3 was found in 14 percent. The result of exocervical biopsy was negative in 34 patients, 3 patients (9 percent) were diagnosed with CIN1 on ECC, and 1 patient (3 percent) had CIN2–3. The association of positive histologic results with the ECC diagnosis was significant (P = .000001). Cone biopsy was performed in 38 patients. The biopsy specimen showed CIN1 in seven patients, five of whom had CIN1 diagnosed by ECC and two of whom had CIN2–3. Fifteen of 18 patients with CIN2–3 indicated by the cone specimen had CIN2–3 indicated by the ECC specimen. In the other three, CIN1 was indicated by ECC. One patient each with CIN1 and CIN2–3 diagnosed in the ECC specimen had microinvasive cancer in the cone biopsy specimen. One woman with an ECC diagnosis of CIN2–3 had invasive cancer found by cone biopsy. In all, 19 of the 23 patients with CIN2–3 (83 percent) had positive results on cone biopsy, and 15 of the 23 had the same diagnosis on cone biopsy and ECC. Five had a more severe diagnosis, including microinvasive or deeply invasive cancer (three women). During 1 year of follow-up, 15 of the 28 patients with CIN1 in the ECC specimen underwent conization. Among these women were five cases of CIN1, three of CIN2–3, and one of microinvasive cancer. J Lower Genital Tract Dis 2000;4:125–127