Using history and colposcopy to select women for endocervical curettage: Results from 2,287 cases

OBJECTIVE: To enhance the yield of endocervical curettage (ECC) by defining risks for abnormality. STUDY DESIGN: Demographic and medical information collected at colposcopy and subsequent histology were reviewed retrospectively. Statistical analysis was by t and X ² tests. RESULTS: Among 2,287 women undergoing ECC at colposcopy, in only 105 (5%) did positive ECC require excisional therapy that would not otherwise have been recommended. Women with positive ECC were older (mean, 39.0 vs. 33.2 years; P <.001) and of higher parity (mean, 3.0 vs. 2.0 births; P <.001), with earlier first intercourse (at 16.6 vs. 17.2 years, P=.O06), more unsatisfactory colposcopil (148 [27%] of 545 women with unsatisfactory colposcopy vs. 183 [12%] of 1,523 women with satisfactory colposcopy; P <.001) and more colposcopic impressions of cervical intraepithelial neoplasia (CIN) 2-3 (163 [51%] of 323 vs. 443 [25.6%] of 1,730 women with low grade or a negative impression; P <.001). The likelihood of missed CIN 2-3 was 0.4%, with no missed cancers among women with satisfactory colposcopy and either a normal colposcopic impression (1/254) or nulliparity (2/474). CONCLUSION: ECC identifies otherwise-undetected preinvasive and invasive lesions but may be avoided in women with satisfactory colposcopy who are nulliparous or have no colposcopic lesions.