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Comparative Risk of High-Grade Histopathology Diagnosis After a CIN 1 Finding in Endocervical Curettage Versus Cervical Biopsy

Gage, Julia C. PhD, MPH1; Duggan, Máire A. MD2; Nation, Jill G. MD3; Gao, Song MSc4; Castle, Philip E. PhD, MPH5

Journal of Lower Genital Tract Disease: April 2013 - Volume 17 - Issue 2 - p 137–141
doi: 10.1097/LGT.0b013e3182630c41
Original Articles

Objective: No evidence-based clinical management recommendations exist for women with an endocervical curettage (ECC) cervical intraepithelial neoplasia grade 1 (CIN 1) result when the concurrent cervical biopsy is not high-grade. For women with these pathologic findings, we assessed their short-term risk of high-grade histopathologic diagnosis in the Calgary Health Region where ECC was routinely performed.

Materials and Methods: We analyzed pathology and colposcopy reports from 1,902 referral colposcopies where both ECC and biopsies were normal or CIN 1. We calculated the short-term risk of CIN 2 or more severe (CIN 2+) detected 12 to 24 months after colposcopy. Pearson χ2 tests or Fisher exact tests were used to compare risks of a CIN 2+ diagnosis between combinations of test results and strata of risk factors.

Results: The short-term risk of CIN 2+ was the same after a CIN 1 biopsy and CIN 1 ECC (4.9% of 1,389 vs 5.0% of 359, respectively, p = .37). Compared with low-grade referral cytology, the risk of CIN 2+ after high-grade cytology was elevated significantly for CIN 1 ECC (13.3% vs 3.3%, p < .01) and nonsignificantly for CIN 1 biopsy (7.1% vs 4.6%, p = .12).

Conclusions: After low-grade cytology, the short-term risk of a high-grade histologic diagnosis in women with either CIN 1 ECC or biopsy is equivalent, suggesting similar management. A CIN 1 ECC may warrant different management in the context of high-grade referral cytology.

The risk of cervical precancer after CIN 1 on either biopsy or endocervical curettage was comparable and may warrant different management after a high-grade cytology.

1Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD; Departments of 2Pathology and Laboratory Medicine and 3Obstetrics and Gynecology, University of Calgary,4Alberta Cervical Cancer Screening Program, Alberta Cancer Board, Alberta, Canada; and 5American Society for Clinical Pathology, Washington, DC

Reprint requests to: Julia C. Gage, PhD, MPH, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 6120 Executive Blvd, Room 7013, MSC 7234, Rockville, MD 20892-7234. E-mail:

Dr Gage was supported by the Intramural Research Program of the National Institutes of Health, National Cancer Institute.

Dr Castle is compensated for serving on a Data and Safety Monitoring Board for HPV Vaccines for Merck. Dr Castle has received HPV tests and testing for research at a reduced or no cost from Qiagen and Merck. The other authors report no conflict of interest.

©2013The American Society for Colposcopy and Cervical Pathology