American Journal of Obstetrics & Gynecology
Volume 203, Issue 5 , Pages 481.e1-481.e9, November 2010

Detection of cervical cancer and its precursors by endocervical curettage in 13,115 colposcopically guided biopsy examinations

  • Julia C. Gage, PhD, MPH

      Affiliations

    • Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
    • Corresponding Author InformationReprints: Julia C. Gage, PhD, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd., Room 7013, MSC 7234, Rockville, MD 20892-7234
    • ,
  • Máire A. Duggan, MD

      Affiliations

    • Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
    • ,
  • Jill G. Nation, MD

      Affiliations

    • Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
    • ,
  • Song Gao, MSc

      Affiliations

    • Alberta Cervical Cancer Screening Program, Alberta Cancer Board, Edmonton, AB, Canada
    • ,
  • Philip E. Castle, PhD, MPH

      Affiliations

    • Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD

Received 8 April 2010; received in revised form 5 May 2010; accepted 17 June 2010. published online 30 August 2010.

Objective

Endocervical curettage (ECC) specimens obtained during colposcopy can detect cervical cancer and precursors otherwise missed by biopsy alone, but the procedure can be painful and reduce compliance with needed follow-up. ECC is routinely performed in the Calgary Health Region colposcopy clinics, permitting a look at its real-world utility.

Study Design

We analyzed pathology and colposcopy reports from 2003 to 2007. We calculated the added diagnostic utility of ECC compared with cervical biopsy alone.

Results

ECC increased the diagnostic yield of cervical intraepithelial neoplasia grade 2 or worse (cervical intraepithelial neoplasia [CIN]2+) in 1.01% of 13,115 colposcopically guided biopsy examinations. Therefore, 99 ECC specimens were taken to detect 1 additional CIN2+. ECC detected 5.4% of 2443 CIN2+ subjects otherwise missed by biopsy alone. Utility was greatest among women aged 46 years or older referred after a high-grade cytology.

Conclusion

ECC is rarely informative when used routinely in colposcopic practice. Older women referred after high-risk cytology benefit most from ECC.

Key words: cervical intraepithelial neoplasia, colposcopy, curettage, diagnosis, endocervical sampling

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 J.C.G. and P.E.C. were supported by the Intramural Research Program of the National Cancer Institute, National Institutes of Health.

 Cite this article as: Gage JC, Duggan MA, Nation JG, et al. Detection of cervical cancer and its precursors by endocervical curettage in 13,115 colposcopically guided biopsy examinations. Am J Obstet Gynecol 2010;203:481.e1-9.

PII: S0002-9378(10)00823-9

doi:10.1016/j.ajog.2010.06.048

American Journal of Obstetrics & Gynecology
Volume 203, Issue 5 , Pages 481.e1-481.e9, November 2010

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