Evaluation of endocervical curettage with conization in diagnosis of endocervical lesions.
OBJECTIVE
Endocervical curettage (ECC) at the time of conization has been reported to be effective for diagnosing cervical intraepithelial neoplasia and/or early stage cervical cancer. We aimed to verify the accuracy of ECC with conization.


METHODS
We retrospectively analyzed the records of 540 patients with suspected neoplastic cervical lesions who underwent conization at the Yokohama City University Hospital from January 2008 to December 2015. To validate the effectiveness of ECC for evaluating endocervical lesions, histopathologic findings from ECC samples were compared with those from endocervical specimens obtained by conization. In patients who subsequently underwent hysterectomy, specimens of residual endocervical stump lesions were compared with the specimens obtained by ECC.


RESULTS
ECC was performed in 58.9% of patients who underwent conization. Positive findings were only observed in 7.9%, while negative findings were found in 67.3% of ECC samples; however, 24.8% of the samples were inadequate for diagnosis. None of the patients had an upgraded diagnosis according to ECC results. The sensitivity of ECC in predicting endocervical stump lesions that were identified by conization specimens was 25.0%, the specificity was 94.2% and the positive predictive value was 55.0% (κ = 0.238; P < 0.001). ECC samples yielded a sensitivity of 42.9%, a specificity of 83.9%, and positive predictive value of 54.5% (κ = 0.284; P = 0.053) in predicting residual endocervical lesions in the uterus.


CONCLUSIONS
As it offers low sensitivity and positive predictive value, ECC at the time of conization is of limited benefit for evaluating endocervical lesions.
Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan.
Yukio
http://orcid.org/0000-0002-2178-6562
Y
Suzuki
Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan.
Tamaki
T
Cho
Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan.
Tae
T
Mogami
Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan.
Naho Ruiz
NR
Yokota
Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan.
Tatsuya
T
Matsunaga
Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan.
Mikiko
M
Asai-Sato
Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan.
Fumiki
F
Hirahara
Center for Translational Research, The Institute of Medical Science Hospital, The University of Tokyo, Tokyo, Japan.
Masanori
M
Nojima
Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan.
Mitsuru
M
Mori
Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan.
Etsuko
E
Miyagi
D000293:Adolescent; D000328:Adult; D000368:Aged; D019092:Conization / Q000379:methods*; D003475:Curettage / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008875:Middle Aged; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000601:surgery; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000601:surgery
cervical intraepithelial neoplasia; conization; curettage; endocervical curettage; hysterectomy