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Endocervical Curettage, Colposcopy


 The pre- and postoperative value of endocervical curettage in the detection of cervical intraepithelial neoplasia and invasive cervical cancer.Fine BA, Feinstein GI, Sabella V. Gynecol Oncol. 1998 Oct;71(1):46-9.

Endocervical curettage helpful in preoperative evaluation of patients who required conization, but not in follow-up care in patients with positive margins. 391 patients studied.



Detection of cervical cancer and its precursors by endocervical curettage in 13,115 colposcopically guided biopsy examinations.Gage JC, Duggan MA, Nation JG, Gao S, Castle PE. Am J Obstet Gynecol. 2010 Nov;203(5):481.e1-9. Epub 2010 Aug 30.
Endocervical curettage detected 5.4% of CIN 2+ otherwise missed by cervical biopsy in 2443 colposcopic cases studied. It was especially helpful in women 46 years of age or older. Otherwise, the yield of CIN 2+ in over 13,000 cases was just over 1%.



The value of endocervical curettage as part of the standard colposcopic evaluation.Granai CO, Jelen I, Louis F, Kawada CY, Curry SL. J Reprod Med. 1985 May;30(5):373-5.
In 278 colposcopic exams studied, the abnormal ECC rate in satisfactory colposcopy was 11.5%. in 22% of cases where biopsy and ECC were performed, the ECC was of higher grade.



The utility of endocervical curettage: does routine ECC at the time of colposcopy for low-grade cytologic abnormalities improve diagnosis of high-grade disease?Rose JD, Byun SY, Sims SM, Davis JDAm J Obstet Gynecol. 2012 Jun;206(6):530.e1-3. Epub 2012 Mar 29.
Of 374 women with ASCUS or LSIL Pap smears undergoing colposcopy; of those with a visible lesion at colposcopy, all underwent biopsy and ECC. There were 16 cases of CIN 2+ on ECC (4.3%), but only just over 1% had solely endocervical high grade CIN.



  Pooled analysis on the necessity of random 4-quadrant cervical biopsies and endocervical curettage in women with positive screening but negative colposcopy.

 2017 Apr;96(17):e6689. doi: 10.1097/MD.0000000000006689  

 Our paper aims to determine the indications for random biopsies and ECC among these screened positive women.Three thousand two hundred thirteen women with any positive screening test result but negative colposcopy, who received random 4-quadrantbiopsies, were pooled from 17 population-based cervical cancer screening studies done in China from 1999 to 2008. The detection rates of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and CIN grade 3 or worse (CIN3+) stratified by cytology and high-risk human papillomavirus (HR-HPV) status were assessed, as well as the false negative rates for CIN2+ and CIN3+ by random biopsies without ECC.Compared with women with negative cytology and positive HR-HPV, those with atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion (ASC-US/LSIL) and negative HR-HPV had the equivalent lower risks of CIN2+ and CIN3+, but ascending risks were observed in the groups of ASC-US/LSIL and positive HR-HPV, and atypical glandular cells/atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion/high-grade squamous intraepithelial lesion or worse (AGC/ASC-H/HSIL+). If random biopsies were only taken without ECC, 9.3% of CIN2+ and 18.5% of CIN3+ would have been missed.For women with any positive screening but negative colposcopy, in areas with good cytological infrastructure, it was necessary to perform random biopsies plus ECC on those with cytological ASC-US/LSIL and positive HR-HPV, AGC, ASC-H, or HSIL+. In contrast, those with other results should be followed up.

Doo DW, Stickrath EH, Mazzoni SE, Alston MJ.   J Low Genit Tract Dis. 2016 Oct;20(4):296-9.

The study sought to evaluate agreement between an abnormal endocervical brush (ECB) collected at the time of colposcopy and subsequent endocervicalcurettage (ECC). Seventy nine cases were included for comparison.   Only 4 of 54 women with low-grade ECB correlated with the ECC pathology grade.  47 of 54 cases were showed normal histology (87% overcall). Only 4 or 25 women with high-grade ECB correlated with the histological findings on ECC.  Twenty of 25 patients had normal histology (80% overcall rate). 

Utility of random cervical biopsy and endocervical curettage in a low-risk population. Pretorius RG, Belinson JL, Azizi F, Peterson PC, Belinson S.

J Low Genit Tract Dis. 2012 Oct;16(4):333-8.   

Of 4932 colposcopies performed 5.1% of CIN 3+ was diagnosed on ECC only.  The authors state that colposcopiy in women over 25 should include ECC.

 2017 Dec;130(6):1218-1225. doi: 10.1097/AOG.0000000000002330.
Diagnosis of Cervical Precancers by Endocervical Curettage at Colposcopy of Women with Abnormal Cervical Cytology.
Using conventional, not minimally invasive brush methods for ECC according to accepted guidelines, the use of ECC found the following:  detected 14.4% CIN 2 or worse (95% CI 10.0-20.2%). Endocervical curettage was more likely to find disease in the endocervix among women with high-grade cytology, positive HPV-16 infection, or high-grade colposcopic impressions (respective P values <.05). Among women with ASC-US or LSIL cytology, those with an unsatisfactory examination had a 13.0% CIN 2 or worse yield on ECC (95% CI 6.1-25.7); when colposcopic examination was normal or satisfactory with visible abnormal lesions, ECC detected less than 5% CIN 2 or worse in the endocervix. An ASC-H or HSIL or worse cytology was associated with a CIN 2 or worse yield of 25.8% by ECC (95% CI 16.6-37.9%). However, ECC found only 3.9% (95% CI 1.9-7.8%) additional CIN 2 or worse beyond the cumulative disease detected by up to four biopsies of visible acetowhite ectocervical lesions. Additional CIN 2 or worse yield by ECC increased when fewer lesion-directed biopsies were taken (P<.05).  It is not usual practice to perform 4 quadrant biopsies in routine colposcopy, thus ECC contributes significantly to occult CIN 2+ detection.