Objective
To determine the use of endocervical curettage at the time of colposcopy for low-grade cytologic abnormalities.
Study Design
We conducted a retrospective chart review of women with low-grade Papanicolaou smears who had undergone satisfactory colposcopic examinations with identifiable lesions. We evaluated results during a 2-year period thereafter to determine whether endocervical curettage increased the diagnosis of high-grade dysplasia.
Results
The study group consisted of 374 patients. Of these patients, 16 had endocervical curettages suggestive of high-grade dysplasia. Of these 16 patients, 4 did not have concomitant high-grade dysplasia identified on ectocervical biopsy. Therefore, 93 to 94 endocervical curettages needed to be performed to detect 1 case of high-grade dysplasia that would not have been identified otherwise.
Conclusion
Routine endocervical curettage at the time of satisfactory colposcopy for low-grade cytologic abnormalities with a visible lesion does not significantly improve the diagnosis of high-grade dysplasia.
Fifty-five million Papanicolaou (Pap) smears are performed annually in the United States. Five to 6% of these Pap smears are read as atypical squamous cells of unknown significance (ASC-US) and an additional 2 to 3% show changes consistent with a low-grade squamous intraepithelial lesion (LSIL). According to the ASCUS-LSIL Triage Study, a randomized multicenter trial involving more than 5000 patients, cervical intraepithelial neoplasia (CIN) 2 or 3 is identified in 12-16 % of women with either LSIL or ASC-US who test positive for high-risk (HR) HPV DNA. Given that ASCUS/(+) HR HPV and LSIL are responsible for the majority of abnormal Pap smears requiring further evaluation, a careful examination of testing prompted by these cytologic abnormalities is warranted. The purpose of our study was to determine the use of endocervical curettage (ECC) for the diagnosis of high-grade dysplasia at the time of colposcopy for women with low-grade cytologic abnormalities.
Materials and Methods
We randomly selected for retrospective review the charts of 732 women who had undergone colposcopy at our institution between Jan. 1, 2006, and Dec. 31, 2009. The study group consisted of patients with low-grade cytologic abnormalities, ASC-US/(+) HR HPV, or LSIL, who had undergone colposcopy and ECC in whom the colposcopic examination was satisfactory and an ectocervical lesion was identified. Patients were excluded from the study if their index Pap smear showed high-grade changes or glandular abnormalities, if they were younger than 21 years of age, if they were pregnant or immune compromised, if they had not had an ECC performed, or if they did not have a visible lesion or an adequately visualized transformation zone at the time of colposcopy. Pap smear, ectocervical biopsy, ECC, and loop electrosurgical excision procedure (LEEP) or cone biopsy results obtained at the initial colposcopy and within 2 years of the initial colposcopy were reviewed and analyzed. Approval from the University of Florida Institutional Review Board was granted before chart review.
Results
The charts of 732 patients were selected for review. One hundred seventy-one patients were excluded because the index Pap smear showed HSIL or glandular changes. An additional 187 patients were excluded based on the above-listed exclusion criteria. Three hundred seventy-four patients remained who had undergone colposcopy and ECC for low-grade cytologic abnormalities in whom the colposcopic examination was satisfactory and a lesion was identified ( Figure ).
Patients in the study group ranged in age from 21 to 67 years and had a mean age of 28 years; 73% of the patients were multiparous and 53% were smokers.
Of the 374 study patients, 75 (20%) had ectocervical biopsies that showed CIN 2 or CIN 3 ( Table 1 ). Sixteen patients (4.2%) had high-grade dysplasia identified on ECC ( Table 2 ). No patients had invasive cancer identified. Of the 16 patients in whom high-grade endocervical disease was identified, 12 also had high-grade disease present on an ectocervical biopsy. Thus, only 4 of 374 patients (1.1%) with low-grade Pap smears, satisfactory colposcopic examinations, and visible lesions had high-grade dysplasia identified on their ECC alone. Therefore, 93 to 94 ECCs needed to be performed to identify 1 case of high-grade dysplasia that would not have been identified by colposcopically directed ectocervical biopsy.
| Variable | NIL | CIN 1 | CIN 2 | CIN 3 | Total |
|---|---|---|---|---|---|
| ASCUS | 81 (61%) | 28 (21%) | 14 (10%) | 11 (8%) | 134 |
| LSIL | 120 (50%) | 70 (29%) | 27 (11%) | 23 (9%) | 240 |
