Colposcopy Standards: Guidelines for Endocervical Curettage at Colposcopy

Abstract

ObjectiveThe most recent guidelines for colposcopy practice in the United States, the 2017 Colposcopy Standards Consensus Guidelines, did not include recommendations for endocervical curettage (ECC). This document provides updated guidelines for use of ECC among patients referred for colposcopy.MethodsConsensus guidelines for the use of ECC were developed in 2012. To update these guidelines in concordance with the 2017 Colposcopy Standards process, an expert workgroup was convened in 2021. Literature had been previously reviewed through 2011, before the 2012 guideline. Literature from the years 2012–2021 and data from the NCI Biopsy study were reviewed, focusing on the additional yield of ECC.ResultsEndocervical curettage is recommended for patients with high-grade cytology, human papillomavirus 16/18 infection, positive results on dual staining for p16/Ki67, for those previously treated for known or suspected cervical precancer or considering observation of cervical intraepithelial neoplasia grade 2, and when the squamocolumnar junction is not fully visualized at colposcopy. Endocervical curettage is preferred for all patients aged older than 40 years. Endocervical curettage is acceptable for all nonpregnant patients undergoing colposcopy but may be omitted when a subsequent excisional procedure is planned, the endocervical canal does not admit a sampling device, or in nulliparous patients aged younger than 30 years, with cytology reported as atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion regardless of whether the squamocolumnar junction is fully visualized. Endocervical curettage is unacceptable in pregnancy.ConclusionsThese guidelines for ECC add to the 2017 consensus recommendations for colposcopy practice in the United States.

Cervical Cancer Screening

“…However, biopsy may be deferred for low-risk patients, defined as cytology of NILM, ASC-US, or LSIL, no evidence of HPV-16 or -18 infection, and no visible abnormalities. In addition to biopsies of all acetowhite areas, sampling of the endocervical canal with endocervical curettage is recommended for high-grade cytology (ASC-H, HSIL, or AGC), HPV-16 or -18 infection, positive results on dual stain, following precancer treatment, during observation of CIN2, and when the squamocolumnar junction is not fully visualized; endocervical curettage is preferred for those aged 40 years or older . During pregnancy, biopsies should be deferred unless there is concern for cancer, and endocervical curettage is contraindicated …”

Endocervical curettage for diagnosing high-grade squamous intraepithelial lesions or worse in women with type 3 transformation zone lesions: a retrospective, observational study

“…This is consistent with the findings of Schneider et al [ 15 ] and Shepherd et al [ 16 ], who found that ECC was of most benefit to women older than 50 years, in terms of decreasing the incidence of cervical cancer and mortality. In the latest standarizing colposcopy guidelines, it is suggested to American practitioners that all patients over 40 years old should initially choose cervical curettage [ 8 ]. However, there is still no united view of the cut-off age and studies of more varied ethnicities are required to understand this.…”

“…It is noteworthy that an ECC abnormality is an independent risk factor for residual disease after LLETZ [ 35 , 36 ]. However, the latest guidelines stipulate that if a subsequent resection is planned, the sampling device should not be placed in the cervical canal [ 8 ]. Therefore, attention should be paid to the results of ECC, follow-up monitoring should be strengthened, and risk factors should be considered in the selection of individualized diagnostic and treatment methods, which may play an active role in cervical intraepithelial neoplasia and residual tumors after surgery.…”

“…The value of ECC in HSIL+ detection remains controversial, with a detection rate of only 1–9.3% observed in previous studies [ 4 , 5 ]. ECC is also invasive, and repeated pulling and scraping in the cervical canal can be painful for patients and reduce the likelihood of attending follow-up appointments [ 6 – 8 ]. Additionally, specimen cosistency obtained by ECC is only moderate (κ = 0.52) [ 9 ] and interobserver agreement is poor [ 10 ].…”

Management of Abnormal Cervical Cancer Screening Test: A Risk-based Approach

“…The following is a summary of the ASCCP recommendations for the use of ECC. 41 ECC recommended: The ASCCP has created and maintains a clinical decision support tool for clinicians. 42 The ASCCP tool is available as a website (free of charge) or phone app (~$10 USD).…”