Diagnostic utility of endocervical curettage in women undergoing colposcopy for equivocal or low-grade cytologic abnormalities

Objective: To estimate the diagnostic yield of endocervical curettage (ECC) when performed as part of a colposcopic procedure in the multicenter ASCUS-LSIL Triage Study (ALTS), a randomized trial of management strategies for women with equivocal or mildly abnormal cytology. Methods: A total of 1,119 women in ALTS had colposcopic examinations that included an ECC performed at the discretion of the colposcopist. We compared the results of ECC and concurrent cervical colposcopic evaluation, with or without biopsy, in prediction of final histopathologic diagnosis. This was defined as the worst histopathologic result from that colposcopy or any subsequent procedure during 2 years of follow-up. Results: Overall, 3.7% of ECCs yielded a diagnostic abnormality of cervical intraepithelial neoplasia (CIN) 2+ compared with 21.7% of colposcopically directed biopsies. In women ultimately found to have CIN 2+ in the trial, the overall sensitivity of colposcopically directed biopsy was 72.5%, compared with 12.2% for ECC. In women under 40, the marginal contribution of ECC, independently of biopsy, was only 2.2%. By contrast, among women 40 and older, the sensitivity of biopsy dropped while the sensitivity of ECC improved, resulting in 13.0% increased detection with ECC, independently of biopsy. However, in women 40 and older, the combined sensitivity of ECC and biopsy was only 47.8% for a single colposcopy procedure. Conclusion: As an ancillary diagnostic technique to colposcopically directed biopsy, ECC is of questionable value in younger women. However, in women aged 40 and older, the sensitivity of colposcopic biopsy decreased and the sensitivity of ECC increased. Thus, ECC may be useful in older women undergoing colposcopy for equivocal or mildly abnormal cytology.