The Pre- and Postoperative Value of Endocervical Curettage in the Detection of Cervical Intraepithelial Neoplasia and Invasive Cervical Cancer

Fine, Ben S.; Feinstein, Glen I.; Sabella, Vincenzo

doi:10.1006/gyno.1998.5120

Cited by 34 publications

(3 citation statements)

References 7 publications

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“…The Resection status R1-resection together with abnormal Pap smear themselves are risk factors for dysplastic cells in the ECC after LLETZ. Cells of HSIL found in the ECC during aftercare are adequate risk factors for remaining or recurrent dysplasia after LLETZ, even if Pap smear or biopsy were negative [10,12,21,22]. In congruence to this, especially cranial (= endocervical) R1-resection signi cantly increases the risk of redysplasia [5,9,12,13].…”

Section: Discussionmentioning

confidence: 99%

The value of endocervical curettage during large loop excision of the transformation zone in combination with endocervical surgical margin in predicting persistent/recurrent dysplasia of the uterine cervix: a retrospective study

Scherer-Quenzer,

Findeis,

Herbert

et al. 2024

Preprint

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Background Cervical cancer often originates from cervical cell dysplasia. Previous studies mainly focused on surgical margins and high-risk human papillomavirus persistence as factors predicting recurrence. New research highlights the significance of positive findings from endocervical curettage (ECC) during excision treatment. However, the combined influence of surgical margin and ECC status on dysplasia recurrence risk has not been investigated. Methods In this retrospective study, data from 404 women with high-grade squamous intraepithelial lesions (HSIL) who underwent large loop excision of the transformation zone (LLETZ) were analyzed. Records were obtained retrospectively from the hospital’s patient database including information about histopathological finding from ECC, endocervical margin status with orientation of residual disease after LLETZ, recurrent/persistent dysplasia after surgical treatment and need for repeated surgery (LLETZ or hysterectomy). Results Patients with cranial (= endocervical) R1-resection together with cells of HSIL in the ECC experienced re-surgery 17 times. With statistical normal distribution, this would have been expected to happen 5 times (p < 0.001). The Fisher’s exact test confirmed a statistically significant connection between the resection status together with the result of the ECC and the reoccurrence of dysplasia after surgery (p < 0,001). 40,6% of the patients with re-dysplasia after primary LLETZ had shown cranial R1-resection together with cells of HSIL in the ECC. Investigating the risk for a future abnormal Pap smear, patients with cranial R1-resection together with dysplastic cells in the ECC showed the greatest deviation of statistical normal distribution with SR = 2.6. Conclusion Our results demonstrate that the future risk of re-dysplasia, re-surgery, and abnormal Pap smear for patients after LLETZ due to HSIL is highest within patients who were diagnosed with cranial (endocervical) R1-resection and with cells of HSIL in the ECC in their primary LLETZ. Consequently, the identification of patients, who could benefit of intensified observation or required intervention could be improved.

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Section: Discussionmentioning

confidence: 99%

The value of endocervical curettage during large loop excision of the transformation zone in combination with endocervical surgical margin in predicting persistent/recurrent dysplasia of the uterine cervix: a retrospective study

Scherer-Quenzer,

Findeis,

Herbert

et al. 2024

Preprint

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“…What is also indicated is a high percentage of false negative and false positive results of ECC amounting to 45% and 25%, respectively [15]. A direct comparison was also made of ECC with cytology in a follow-up in women after the treatment of uterine cervix dysplasia which revealed the superiority of cytology [1,19]. ASCCP recommendations with respect to the collection of material from the uterine cervix canal include both the brush and the traditional biopsy (ECC) [20].…”

Section: Discussionmentioning

confidence: 99%

Is routine performance of the uterine cervix canal curettage prior to the curettage of the uterine cavity justified?

Piątek

Lipa²,

Górska³

et al. 2017

Ginekol Pol

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Objectives: Endocervical curettage (ECC) together with the dilatation and curettage of the uterine cavity (D & C) is routinely performed in everyday clinical practice. The aim of this study is to assess the rationale of the performance of ECC prior to D & C in indications other than abnormal uterine bleeding (AUB). Material and methods:Case histories of 736 patients after ECC performed in the 1 st Department of Obstetrics and Gynaecology, Medical University of Warsaw, were analyzed retrospectively, the indications for the procedure -age, menopausal status, parity, procedure operator's experience -as well as the result of the histopathology examination were taken into account. Three groups of patients were distinguished based on the indications for the procedure. Results:In 645 (87.6%) of cases normal histopathology results were obtained. 40 (5.4%) cases were abnormal. 31 cases of uterine cervix dysplasia were disclosed (CIN 1-20; CIN 2-5; CIN 3-6), 8 cases of endometrial cancer and 1 case of cancer of the uterine cervix were disclosed. In 51 (7%) of cases tissue material for histopathology examination was not obtained. In patients where ECC and D & C were performed due to indications other than abnormal bleeding from uterine cavity, no abnormal results were revealed. In addition, in this group the highest number of non-diagnostic ECCs was reported (11.59%; p < 0.05). Conclusions:In the case of endometrial biopsy for indications other than AUB routine ECC prior to D & C need not be performed.

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“…[14] of the 15 women diagnosed with squamous carcinoma, ECC was the only evidence of invasion in 7 of these women (47%), although the investigators noted that the ECC was useful mostly in detecting disease in women who had an unsatisfactory or normal colposcopic examination. Fine et al [15] reported that 6 of 17 women diagnosed with carcinoma and a positive ECC had normal colposcopy and in 5 or 6 of these women, positive ECCs were the only indication to perform a cone biopsy. Ferenczy [16] reported that 19 women who had unsuspected carcinoma were identified with ECCs, although 18 of these 19 women also had unsatisfactory colposcopy.…”

Section: Contaminationmentioning

confidence: 99%

Is endocervical curettage necessary? A literature review

Herold

2012

JNEP

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Background: Invasive cervical cancer develops from a pre-invasive state named cervical intraepithelial neoplasia (CIN). CIN 1 represents mild dysplasia and is now classified as low-grade squamous intraepithelial lesion (LGSIL); CIN 2 and 3 lesions encompass moderate-to-severe dysplasia and are now classified as high-grade squamous intraepithelial lesions (HGSILs) based on the Bethesda cervical cytology reporting system. Most LGSIL lesions resolve spontaneously, whereas HGSIL lesions are more likely to progress to invasive cervical cancer. However, HGSILs are typically detected an average of 10 to 15 years before invasive cervical cancer. In women, the typical age range for diagnosis of invasive cancer is greater than 40 years. High-risk Human Papilloma Virus (HRHPV) infection is required for the development of virtually all cervical cancer, and the time from initial HPV infection to development of cervical cancer usually exceeds 10 years. Colposcopies that are performed for abnormal papanicolaou (pap) smears of LGSIL and HRHPV can include ectocervical and endocervical biopsies. Given the likelihood of (a) spontaneous resolution of LGSIL and HRHPV, (b) the time to development of cervical cancer after initial diagnosis of HPV and (c) the improbability of invasive cervical cancer developing in women less than 40 years of age, there is evidence to suggest that endocervical curettage at the time of colposcopy is not necessary in a subgroup of women who are at low risk of developing invasive cervical cancer. At the current time, no evidence based guidelines exist about the necessity of endocervical curettage (ECC) at the time of colposcopy in women who are at low risk for invasive cervical cancer. Therefore, a literature review was conducted to analyze literature as it related to ECC at the time of colposcopy in who are at low risk for invasive cervical cancer. A particular subgroup of women that are at low risk for development of cervical cancer are less than 35 years of age with LGSIL or HRHPV cytology, and women who are less than 35 years of age are at an even lower risk of developing invasive cervical cancer because of their more robust immune system. The purpose of the literature review was to summarize findings about endocervical curettage at the time of colposcopy to propose a study that could be conducted to establish evidence based guidelines for ECC that could be utilized in practice. Methods:The literature review summarizes current empirical and theoretical knowledge related to ECC at the time of colposcopy in women who are less than 35 years of age with LGSIL or HRHPV cytology. Concepts and keywords of the proposed literature review include: ECC-based diagnosis in each of three categories (benign, CIN 1 and CIN >1), ectocervical-based biopsy in each of three categories (benign, CIN 1 and CIN >1), LGSIL, HRHPV, colposcopy, and cervical cancer. Primary and secondary literature was examined to elucidate gaps in the literature related to evidence based guidelines for ECC at the time of colposcopy. Resu...

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The Pre- and Postoperative Value of Endocervical Curettage in the Detection of Cervical Intraepithelial Neoplasia and Invasive Cervical Cancer

Cited by 34 publications

References 7 publications

The value of endocervical curettage during large loop excision of the transformation zone in combination with endocervical surgical margin in predicting persistent/recurrent dysplasia of the uterine cervix: a retrospective study

The value of endocervical curettage during large loop excision of the transformation zone in combination with endocervical surgical margin in predicting persistent/recurrent dysplasia of the uterine cervix: a retrospective study

Is routine performance of the uterine cervix canal curettage prior to the curettage of the uterine cavity justified?

Is endocervical curettage necessary? A literature review

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