Академический Документы
Профессиональный Документы
Культура Документы
Precancers by
Endocervical Curettage
at Colposcopy of
Women With Abnormal
Cervical Cytology
JOURNAL READING
Diagnosis of Cervical Precancers by Endocervical Curettage at Colposcopy of Women With Abnormal Cervical Cytology
Introduction
Objective
To evaluate the performance of routine
endocervical curettage (ECC) for diagnosing
high-grade cervical intraepithelial neoplasia
(CIN) 2 or worse and additional precancers not
otherwise detected by ectocervical biopsies.
Diagnosis of Cervical Precancers by Endocervical Curettage at Colposcopy of Women With Abnormal Cervical Cytology
Methods
2,270 women The diagnostic
Women were
referred to the value of ECC for
referred with one
colposcopy clinic 690 of 1,373 detecting
of the following
at the University (50.3%) eligible additional disease
diagnoses: ASC-
of Oklahoma women agreed to was evaluated by
US, LSIL, ASC-H,
Health Sciences participate in the the number of
HSIL, AGC, AIS,
Center February study lesion-directed
and squamous
2009 - September ectocervical
cell carcinoma
2012 biopsies.
Diagnosis of Cervical Precancers by Endocervical Curettage at Colposcopy of Women With Abnormal Cervical Cytology
Data Collection
Discussion
our finding of 10.1% CIN 2 or worse yield on ECC in women 20–29 years old implicates that AGC
or AIS cytology, unsatisfactory examination as well as discrepancy between HSIL cytology and
normal examination remain important considerations for performing ECC in young women
In the Biopsy Study, selecting for the ECC procedure by age alone affirmed previously reported
associations between diagnosing cervical precancers on routine ECC and high-grade colposcopic
impression and ASC-H or HSIL or worse cytology.
For the first time, we described an association between HPV-16 infection and positive ECC
among women 45 years old or older (Tables 3 and 4).
Diagnosis of Cervical Precancers by Endocervical Curettage at Colposcopy of Women With Abnormal Cervical Cytology
Discussion
Given acetowhitening is highly sensitive for the detection of cervical precancers, the
additional yield of CIN 2 or worse by ECC was less than 10% in our study even when
the worst-appearing colposcopic lesion was the only ectocervical biopsy taken.
Conclusion
The additional yield of CIN 2 or worse by ECC in a colposcopy with up to
four ectocervical biopsies was low.
• Endocervical Curettage
INTERVENTION
Endocervical curettage was more likely to find disease in the endocervix among women with high-grade
cytology, positive HPV-16 infection, or highgrade colposcopic impressions (respective P values <,.05).
ECC found only 3.9% (95% CI 1.9– 7.8%) additional CIN 2 or worse beyond the cumulative disease detected
by up to four biopsies of visible acetowhite ectocervical lesions. Additional CIN 2 or worse yield by ECC
increased when fewer lesion-directed biopsies were taken (P<,.05).
Diagnosis of Cervical Precancers by Endocervical Curettage at Colposcopy of Women With Abnormal Cervical Cytology
Information bias No
Diagnosis of Cervical Precancers by Endocervical Curettage at Colposcopy of Women With Abnormal Cervical Cytology
In the Biopsy Study, selecting for the ECC procedure by age alone affirmed
previously reported associations between diagnosing cervical precancers on
routine ECC and high-grade colposcopic impression and ASC-H or HSIL or worse
cytology.
Our findings support the following ECC indications in the current cervical cancer
screening guidelines: 1) ASC-H or HSIL or worse cytology and 2) ASC-US or LSIL
cytology with unsatisfactory colposcopy. Using a multiple-biopsy colposcopy
protocol, we showed that detection of additional CIN 2 or worse by ECC
substantially decreases with increasing number of ectocervical biopsies
Diagnosis of Cervical Precancers by Endocervical Curettage at Colposcopy of Women With Abnormal Cervical Cytology
In contrast to previous research, we showed that ECC did not yield significantly
more disease in unsatisfactory examinations in women 30–44 years old