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Which Colposcopies Should Include Endocervical Curettage?

Pretorius, Robert G. MD1; Belinson, Jerome L. MD2; Peterson, Patricia1; Burchette, Raoul J. MS3

Journal of Lower Genital Tract Disease: October 2015 - Volume 19 - Issue 4 - p 278–281
doi: 10.1097/LGT.0000000000000119
Original Articles: Cervix and HPV

Objectives Although endocervical curettage (ECC) is often performed at colposcopy, it remains unclear whether it should be done in all women, only women over a certain age, only women with unsatisfactory colposcopy, or only in women with normal colposcopic impressions. To clarify the indications for ECC, we determined the proportion of colposcopies with CIN 3, or cancer (CIN 3+) detected only by ECC showing CIN 2, CIN 3, or cancer (CIN 2+).

Methods Review of electronic medical records from colposcopy clinics.

Results Between March 1, 1996, and April 23, 2013, approximately 18,537 cervical colposcopies with no missing results evaluated women with abnormal cervical cytology and/or positive high-risk human papillomavirus tests. In 7.5% (1,398/18,537) of colposcopies, the final diagnosis, based on the worst biopsy from cervix; ECC; or subsequent loop electrocautery excision procedure, cervical conization, or hysterectomy, was CIN 3+. The proportion of colposcopies with CIN 3+ detected only by ECC showing CIN 2+ was 0.5% (101/18,537). Limiting the ECC to women with unsatisfactory colposcopy, colposcopic impressions suggestive of CIN 2+, or impressions of normal resulted in fewer ECC performed but also greatly decreased the proportion of CIN 3+ that could have been detected only by ECC showing CIN 2+. Limiting the ECC to colposcopies in women age 25 years and older resulted in 29.3% (5,433/18,537) fewer ECCs while detecting 96.0% (97/101) of the CIN 3+ that could have been detected only by ECC showing CIN 2 + .

Conclusions Endocervical curettage should be performed at colposcopy in women age 25 and older.

Endocervical curettage (ECC) should be obtained at colposcopy on women age 25years and older.

1Department of Obstetrics and Gynecology, Southern California Permanente Medical Group (SCPMG)–Fontana, Fontana, CA; 2Preventive Oncology International, Cleveland Heights, and the Women’s Health Institute, Cleveland Clinic, Cleveland, OH; and 3Department of Research and Evaluation, SCPMG–Los Robles, Pasadena, CA

Reprint requests to: Robert G. Pretorius, MD, Southern California Permanente Medical Group–Fontana, Department of Obstetrics and Gynecology, 9961 Sierra Ave., Fontana, CA 92335. E-mail:

Conflicts of Interest and Source of Funding: None of the authors have declared conflict of interest, and there is no funding source.

Copyright © 2015 by the American Society for Colposcopy and Cervical Pathology