Endocervical curettage in evaluating abnormal cervical cytology

OBJECTIVE: To determine the role of endocervical curettage (ECC) in the eva luation of women with abnormal cervical cytology and following treatment fo r cervical intraepithelial neoplasia. STUDY DESIGN: A retrospective chart review using the records of 2,126 patie nts who were seen at the Colposcopy Clinic, Baylor College of Medicine, bet ween 1980 and 1995. All patients were referred because of an abnormal cervi cal smear and underwent repeat Pap smear, colposcopic examination in each c ase with biopsies as indicated, endocervical curettage and treatment, consi sting of either cryotherapy, laser vaporization or a LOOP electrosurgical e xcision procedure. Following treatment, Pap smears were performed an a sche duled basis, and ECC was performed annually. RESULTS: The ECC was negative in 1,849 (87%) of the women. It was abnormal in 33% of women with unsatisfactory colposcopy and 10% of women with satisf actory colposcopy. ECC was abnormal in 21% of patients with a negative biop sy result and 42% of patients who did not have a biopsy performed. There wa s a significant increase in abnormal ECC results with increasing age. ECC h ad a high positive predictive value for ectocervical disease (86%) and a hi gh negative predictive value for endocervical disease (90%). One year follo wing treatment, <4% of patients with a negative cervical smear had a high g rade lesion detected on ECC. CONCLUSION: The use of ECC is helpful in detecting disease missed by routin e colposcopy and biopsy and is most likely to detect ectocervical disease r ather than true endocervical disease. Following treatment, ECC does not app ear to be significantly more reliable than the Pap smear in detecting the p resence of significant residual disease.