The role of endocervical curettage in detection and treatment of cervical canal lesions

Abstract

Objective. To screen out high-risk groups of endocervical lesions, explore the effect of length of excision on margin status in women with abnormal endocervical curettage (ECC) and explore the role of ECC in the additional detection of high-grade squamous intraepithelial lesion or worse (HSIL+) under colposcopy and lesion-targeted biopsies. Methods. The study included 936 patients who underwent loop electrosurgical excision procedure (LEEP) for cervical lesions which were diagnosed by cervical biopsy and ECC at the cervical clinic of the First Affiliated Hospital of Chongqing Medical University from January 2014 and December 2018. The correlations among abnormal ECC, human papillomavirus (HPV) type, cytology, margin of excision, and age were analyzed by Pearson's χ2 test and multivariate logistic regression analysis. Results. Abnormal ECC was associated with HPV16 infection (P<0.001), or HSIL cervical cytology or worse (P<0.001), or aged 50 years old or older (P<0.001). Abnormal ECC was associated with positive margin of excision (P<0.001). For patients with abnormal ECC, the length of excision was independent of margin status (P=0.762). Among all the 491 patients with HSIL+ diagnosed by either cervical biopsy or ECC, the additional detection rate of HSIL+ by ECC was only 8.76% (43/491). Conclusion. In our study, ECC was recommended in women with HPV-16 infection, HSIL cervical cytology or worse, aged 50 or older, or invisible transformation zone in colposcopy. At the same time, our results suggested that ECC abnormalities were associated with positive margin of excision. The data did not support performing a longer length of excision in patients with abnormal ECC, especially in women with fertility needs. In summary, patients with abnormal ECC should be given more attention and follow-up to avoid missing residual lesions.