Endocervical curettage when colposcopic examination is satisfactory and normal

Objective: To estimate the incidence of endocervical dysplasia in women wit h cervical cytology of atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (SIL) who have a sati sfactory and normal colposcopic examination. Methods: An electronic colposcopy database was reviewed and women with sati sfactory colposcopic examinations and original cervical cytology of ASCUS o n two consecutive Papanicolaou smears, ASCUS favor SIL, or low-grade SIL we re selected. Exclusion criteria were pregnancy, insufficient endocervical c urettage (ECC), or colposcopic examination that showed an abnormality that required cervical biopsy. Subjects also were excluded if they were postmeno pausal or had surgical or ablative therapy for cervical dysplasia within th e past year. A computerized review of 2517 patient records found 860 that m et the search criteria. A manual review of those records using the exclusio n criteria isolated a study group of 159 women. Results: Four of 159 subjects (2.5%, 95% confidence interval [CI] 0.69, 6.3 ) had dysplastic cells in endocervical curettings. In these four, the ECC s pecimens had benign endocervical cells and separate fragments of squamous c ells with mild dysplasia. In three women, loop electrosurgical excision pro cedures showed mild dysplasia limited to the transformation zone. The fourt h subject was believed to have contamination from an unrecognized ectocervi cal lesion and was treated conservatively. A repeat ECC found benign endoce rvical cells. Involvement of the endocervix by dyplasia was excluded in all but one of 159 patients (0.63%, 95% CI 0.02, 3.5). Conclusion: Incidence of endocervical dysplasia was extremely low in women with cervical cytology of consecutive ASCUS, ASCUS favor SIL, or low-grade SIL who have a satisfactory and normal colposcopic examination. Our finding s suggest that endocervical curettage might be safely avoided in those wome n. (Obstet Gynecol 2000;95:801-3).