Use and Utility of Endocervical Curettage at Colposcopy [21F

Abstract

INTRODUCTION: Few studies have investigated the diagnostic utility of endocervical curettage (ECC) since the 2013 ASCCP Updated Consensus Guidelines. We evaluate the use of ECC at colposcopy for detection of ≥ cervical intraepithelial neoplasia (CIN) two. METHODS: IRB approved retrospective chart review included patients attending colposcopy clinic at a large urban hospital from January 2017 to January 2019 (N=402). From electronic medical records we extracted demographic characteristics, medical comorbidities, insurance status, pap smear cytology, HPV results, and colposcopy results including biopsy or ECC pathology. We used Chi-square to evaluate the use and diagnostic utility of ECC at time of colposcopy for detection of ≥ CIN two. RESULTS: An ECC was performed in 66.9% of colposcopies and 7.8% of those returned with pathology of ≥ CIN two. Transplant recipients were significantly more likely to have an ECC performed during colposcopy (X2(1, N=402)=7.23, P<.05) while ECC was less frequent for those with unsatisfactory pap cytology (70% did not receive ECC, P<.001). Inadequate colposcopy was associated with a higher likelihood of receiving ECC (P<.0001). ECCs were significantly more likely to be performed when cervical biopsy was also performed (74% vs 58% with no biopsy; X2(2, N=402, P<.05). Cervical biopsy CIN results agreed with ECC CIN results (X2(1, N=151)=20.62, P<.0001). In 4.2% of colposcopies, when cervical biopsy revealed no dysplasia or CIN 1, ECC revealed ≥ CIN 2. CONCLUSION: ECCs were performed more frequently in transplant patients, inadequate colposcopy, and when cervical biopsy was also obtained. In most cases ECC did not change management.