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Contribution of Exocervical Biopsy, Endocervical Curettage, and Colposcopic Grading in Diagnosing High-Grade Cervical Intraepithelial Neoplasia

Diedrich, Justin Thomas MD1; Felix, Juan C. MD2; Lonky, Neal M. MD, MPH1,3

Journal of Lower Genital Tract Disease: January 2016 - Volume 20 - Issue 1 - p 52–56
doi: 10.1097/LGT.0b013e3182a5296e
Original Research Articles: Cervix and HPV

Objective: To determine the utility of random biopsy and endocervical curettage (ECC) during colposcopy among women who ultimately underwent cervical excisional biopsy.

Materials and Methods: In a retrospective observational study, the charts were reviewed of every patient who underwent cervical excisional procedure performed between June 2010 and August 2011, including the antecedent colposcopic examination and any pathological specimens. A random sample of 15% all pathologic specimens was reviewed. Practice of biopsy, use of ECC, demographic factors, referral cytology results, lesion distribution, and size were assessed for correlation with high-grade cervical intraepithelial neoplasia 2 or worse (CIN 2+).

Results: A total of 555 patients were included in our analysis. Of them, 333 (60%) had CIN 2+ on colposcopy or excision. CIN 2+ was most likely in younger women and those referred for high-grade cytology. Among 111 women with no visual lesion seen at colposcopy, 66 underwent ECC alone, 33 had ECC and random biopsy, 9 were referred straight to excision, and 3 underwent random biopsy alone. Of the 99 who underwent ECC, this was consistent with the highest-grade lesion in 68% of cases. Among the 36 with random biopsy, this was consistent with the highest-grade lesion in 72% of cases.

At the time of colposcopy, there were 326 who had CIN 2+ diagnosed with satisfactory colposcopy. Biopsy and ECC were performed in 278 cases. In 235 cases, biopsy alone showed CIN 2+; in 43, the biopsy and ECC both showed CIN 2+. In the remaining 48 cases, CIN 2+ was diagnosed with ECC alone.

Conclusions: In those ultimately treated with excision, younger women and those whose referral cytology was high-grade both were at higher risk of high-grade histology. Random biopsy and ECC (even among satisfactory colposcopy) were significantly associated with disclosure of high-grade pathology.

Endocervical curettage and random biopsy are critical in disclosing cervical cancer precursors.

1Department of Obstetrics and Gynecology, University of California, Irvine; 2Department of Gynecologic Pathology, University of Southern California, Los Angeles; and 3Department of Obstetrics and Gynecology, Kaiser Permanente, Anaheim, CA

Reprint requests to: Neal M. Lonky, MD, MPH, Department of Obstetrics and Gynecology, Kaiser Permanente, Anaheim, CA, 2330 E La Palma Ave, Anaheim, CA 92805, or Department of Obstetrics and Gynecology, University of California, Irvine, CA. E-mail:

The authors have declared they have no conflicts of interest.

This work was supported by the Departments of Obstetrics and Gynecology and Research and Evaluation, Southern California Permanente Group.

Copyright © 2016 by the American Society for Colposcopy and Cervical Pathology