The pre- and postoperative value of endocervical curettage in the detection of cervical intraepithelial neoplasia and invasive cervical cancer.
OBJECTIVE
The study was conducted to evaluate the pre- and postoperative value of endocervical curettage (ECC) in the detection of cervical intraepithelial neoplasia and invasive cervical cancer.


METHODS
Patients undergoing cervical conization were studied retrospectively to evaluate the correlation of grade of preoperative endocervical curettage and the grade of dysplasia in the conization specimen. The role of routine preoperative ECC in satisfactory and unsatisfactory colposcopy and the need for routine ECC in the detection of postoperative residual dysplasia was also evaluated.


RESULTS
Results showed that 297/391 (76%) patients had ECC as part of preoperative assessment for cervical dysplasia on Papanicolaou smear. There was good association of grade of preoperative ECC and grade of conization specimen, weighted kappa-0.135 (P = 0.0003). Of 17 patients with invasive disease on conization specimen, only patients with a positive ECC had invasion at conization. None of 113 patients with a negative preoperative ECC had invasive disease on their conization specimens. The proportion of satisfactory colposcopic examinations between positive and negative ECC is not significantly different (P = 0.673). Follow-up of positive margins of resection was performed with Papanicolaou smear in only 20 patients and with Papanicolaou smear and ECC in 53 patients. In the latter group, 4% had a positive ECC with negative Papanicolaou smear (P = 0.310).


CONCLUSIONS
There is good agreement between grade of dysplasia on preoperative ECC and on subsequent conization specimen. Colposcopic examination was not a good predictor of pathology in the endocervical canal. Routine ECC should be part of the preoperative assessment of an abnormal Papanicolaou smear but may be unnecessary in the evaluation for residual dysplasia.
Fine
B A
BA
Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78284-7836, USA.
Feinstein
G I
GI
Sabella
V
V
D001706:Biopsy; D002584:Cervix Uteri / Q000473:pathology; D003127:Colposcopy; D019092:Conization; D004107:Dilatation and Curettage; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D018365:Neoplasm, Residual / Q000473:pathology; D011182:Postoperative Care; D011300:Preoperative Care; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D002578:Uterine Cervical Dysplasia / Q000473:pathology*