title: The Value of Endocervical Curettage in Addition to Biopsies in Women Referred to Colposcopy.
abstract: OBJECTIVE
  Performing endocervical curettage (ECC) at colposcopy may increase the yield of cervical intraepithelial neoplasia grade 2 (CIN2) or worse (CIN2+) compared to biopsies alone. The additional benefit of ECC in detecting CIN2+ was studied in women with lesion-targeted biopsies (low-grade or worse impression) and women with biopsies of normal-appearing cervix (less than low-grade impression).
  
  
  METHODS
  In this subanalysis of a multicenter study, 126 women referred to colposcopy who had an ECC were included. Multiple directed biopsies were taken from lesions, and a nontargeted biopsy was added if fewer than 4 biopsies were collected. Risk strata of CIN2+ were evaluated based on cytology and colposcopic appearance to identify women for whom ECC would be most valuable.
  
  
  RESULTS
  The CIN2+ yield of ECC in addition to biopsies was 15 (11.9%) of 126. In women with lesion-targeted biopsies and ECC, the CIN2+ yield of targeted biopsies was 34 (51.5%) of 66, the yield of additional nontargeted biopsies was 1 (1.5%) of 66, and the additional CIN2+ yield of ECC was 5 (7.6%) of 66. The yield in women with nontargeted biopsies only and ECC was 5 (8.3%) 60, and the additional yield for ECC was 10 (16.7%) of 60. Endocervical curettage did not find disease in women with atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion.
  
  
  CONCLUSIONS
  In women with less than low-grade impression and especially those with unsatisfactory colposcopy, the yield of CIN2+ was higher for ECC compared to nontargeted biopsies. The highest yield of CIN2+ from ECC was observed in women with high-grade squamous intraepithelial lesion and less than low-grade impression, suggesting that disease is higher up in the endocervix in this group.
authors.affiliation: 1Department of Research and Development, DDL Diagnostic Laboratory, Rijswijk, The Netherlands; 2Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; 3Department of Pathology, CRESIB (Centre de Recerca en Salut Internacional de Barcelona), Hospital Clínic, Barcelona, Spain; 4Department of Gynaecology, Roosevelt Kliniek, Leiden, The Netherlands; 5Division of Oncology, Department of Gynaecological Oncology, University Medical Center Utrecht, Utrecht, the Netherlands; and 6Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
authors.forename: Jacolien
authors.initials: J
authors.lastname: van der Marel
authors.forename: Agata
authors.initials: A
authors.lastname: Rodriguez
authors.forename: Marta
authors.initials: M
authors.lastname: Del Pino
authors.forename: Romy
authors.initials: R
authors.lastname: van Baars
authors.forename: David
authors.initials: D
authors.lastname: Jenkins
authors.forename: Miekel M
authors.initials: MM
authors.lastname: van de Sandt
authors.forename: Aureli
authors.initials: A
authors.lastname: Torné
authors.forename: Jaume
authors.initials: J
authors.lastname: Ordi
authors.forename: Bram
authors.initials: B
authors.lastname: ter Harmsel
authors.forename: René H M
authors.initials: RH
authors.lastname: Verheijen
authors.forename: Mark
authors.initials: M
authors.lastname: Schiffman
authors.forename: Julia C
authors.initials: JC
authors.lastname: Gage
authors.forename: Wim G V
authors.initials: WG
authors.lastname: Quint
authors.forename: Nicolas
authors.initials: N
authors.lastname: Wentzensen
mesh_terms: D065311:Adenocarcinoma in Situ / Q000175:diagnosis*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D003127:Colposcopy / Q000379:methods*; D004107:Dilatation and Curettage / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*