Objective: 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.
Results: 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.
Conclusions: 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. ▪.