The Pre- and Postoperative Value of Endocervical Curettage in the Detection of Cervical Intraepithelial Neoplasia and Invasive Cervical Cancer

Abstract

Whether or not to perform endocervical curettage (ECC) as a routine part of the preoperative assessment for an abnormal Pap smear or the postoperative examination when positive margins are found in the endocervical specimen after conization is a matter of debate among practitioners. Some think that an adequate preoperative colposcopic examination is sufficient, whereas others find that ECC offers valuable additional diagnostic information that is not dependent on the colposcopist’s ability. In addition, in some centers ECC is routinely performed after conization to detect postoperative residual dysplasia. In this study, the role of ECC in pre- and postoperative evaluation in the detection of cervical intraepithelial neoplasia (CIN) and invasive cervical cancer was investigated. The records of 391 patients who underwent cervical conization for evaluation of abnormal cytology from 1990 to 1996 were reviewed. The preoperative work-up included ECC in 297 women. In some cases, the reason for the decision to perform ECC was indicated (inadequate colposcopic examination, or lack of a visible ectocervical lesion), in others, it was performed as a routine part of the colposcopic examination. Conization of the cervix was performed with either cold knife or loop electrosurgical excision. Follow-up examinations were conducted 3 to 4 months after the procedure and included ECC at the discretion of the physician. Of the 391 patients, 27 had invasive cervical cancer detected by conization. Of these 27, 17 had undergone a preoperative ECC and all 17 specimens were abnormal. CIN III was found in 14 women, invasive cancer was identified in two, and one specimen had no grade specified. Findings on the preoperative ECC were negative in 113 patients. There were no invasive cancers found among these women. There were 184 patients with a positive ECC of whom 148 had also had colposcopic examination as part of their preoperative assessment. The colposcopic examination was described as satisfactory in 110 (74 percent) of these women. Of the 113 patients with a negative ECC, 82 also had a colposcopic examination; 63 (76 percent) were described as satisfactory. There was no statistically significant correlation between satisfactory colposcopy and positive or negative ECC. Follow-up information was available for 73 women of whom 53 had both an ECC and Pap smear as part of the postoperative examination. Two (4 percent) of the 45 women in this group with normal cytology had positive ECC findings. Of the eight patients who had abnormal cervical smears, one (12 percent) had a positive ECC. Gynecol Oncol 1998;71:46–49