Abstract

Endocervical curettage and cone biopsy found no high-grade intraepithelial lesions in premenopausal women who had a satisfactory colposcopic evaluation with low-grade cytology and exocervical biopsies.

A retrospective analysis was performed of patients who underwent cervical cone biopsy to investigate an abnormal cytology. The histology of the cone was compared with the cervical cytology and the ectocervical biopsies. Over a 6-year period, 346 cone biopsies were performed at the UCLA Medical Center. Of these, 338 cone specimens were available for review, 279 had complete colposcopic records, and 227 had both an endocervical curettage and ectocervical biopsy. No premenopausal patients with low-grade cytology, satisfactory colposcopy and a low grade lesion on ectocervical biopsy subsequently had a high-grade lesion or invasive cancer on the cervical cone biopsy. Thus, in these patients the endocervical curettage did not prove to be of diagnostic value. In contrast, five patients with high-grade cytology, satisfactory colposcopy and low-grade ectocervical lesions had positive endocervical curettages and high-grade lesions on cone biopsy. These data suggest that selective use of endocervical curettage in premenopausal patients with satisfactory colposcopy can be based on whether the cytology is low grade or high grade. In premenopausal patients with low-grade cytology and satisfactory colposcopy, endocervical curettage can be omitted, while any patient who has a high-grade cytology should have an endocervical curettage.