title: Which Colposcopies Should Include Endocervical Curettage?
abstract: OBJECTIVE
  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.
authors.affiliation: 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.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Pretorius
authors.forename: Jerome L
authors.initials: JL
authors.lastname: Belinson
authors.forename: Patricia
authors.initials: P
authors.lastname: Peterson
authors.forename: Raoul J
authors.initials: RJ
authors.lastname: Burchette
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003127:Colposcopy / Q000379:methods*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D004107:Dilatation and Curettage / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D055815:Young Adult