To evaluate the role of endocervical curettage (ECC) in the diagnosis of cervical intraepithelial neoplasia.
Materials and Methods.
Retrospectively we studied 581 patients who had ECC, 43 (7.4%) had cervical intraepithelial lesions (CIN) 1 ECC, 23 (4.0%) CIN 2-3 ECC, and 515 negative ECC (88.6%). Analysis of variance was used to compare for age and parity, and Pearson's chi-square test was used to analyze the association with other variables such as cytology, images, acetowhite epithelium, microbiopsy, and ECC. Significance level was set at p = 0.05.
Age for CIN 1 ECC was at 32.3 (16-66) years; parity was at 0.82 (parity 0-7) compared with 35.2 (18-70) years and parity at 1.52 (parity 0-12) for CIN 2-3 ECC, and 36.1 (14-68) years, parity at 1.1 (parity 0-10) for negative ECC. ECC is associated with Cytobrush cytology (Zelsmyr Cytobrush, International Cytobrush Inc., Hollywood. FL) (p = 0.000) in CIN 2-3 ECC and high-grade squamous intraepithelial lesion (HGSIL) cytology. Positive ECC was not overrepresented in unsatisfactory colposcopy (14/61, 23%) compared with negative ECC (158/526, 30%, p = 0.43). If positive ECC is not associated with the presence of significant acetowhite epithelium, a net association (p = 0.000) was observed between CIN 1 microbiopsies and CIN 1 ECC 9 (12/19), and CIN 2-3 biopsies and CIN 2-3 ECC (12/17). Conization for CIN 2-3 ECC (n = 23) yielded 15 CIN 2-3, two CIN 1, one microinvasive cervical cancer, one cancer of the cervix, and four negative cones.
Positive endocervical curettage is associated with endocervical cytology and microbiopsy. In ablative treatments, when low-grade squamous intraepithelial lesion (LGSIL) smear, satisfactory colposcopy, and CIN 1 biopsy is observed, ECC appears unnecessary since CIN 2-3 ECC was not observed in these patients. All other cases should have ECC prior to ablative therapy. CIN 2-3 ECC, commands conization, in order to eliminate invasive cancer, and confirm and treat CIN 2-3. ▪
Reprint requests to: Bernard Lambert, MD, Department of Gynecology, Hotel-Dieu, 3840, St-Urbain, Montréal, Québec, Canada H2W 1T8.
©2000The American Society for Colposcopy and Cervical Pathology