Colposcopic endocervical brushing cytology appears to be more sensitive than histologic endocervical curettage for detecting endocervical adenocarcinoma

Comparison of Sampling Devices for Endocervical Curetting

Introduction

Endocervical curetting (ECC) is mandatory when colposcopy is inadequate or when the Pap smear suggests glandular lesion. When the curette is used, ECC is painful; this necessitated the development of the endocervical brush. There is no consensus on which device yields more sample, detects true cervical precancer (CIN2+) better or highlights the effects of age and parity on ECC yield.

Objective

To compare ECC yield and the ability to pick up CIN2+ by the different devices and effect of parity and age on yield.

Method

Three hundred women referred for colposcopy following positive cervical high-risk HPV DNA test who had inadequate colposcopic examination were randomly allocated to curette, brush and curette and brush groups for ECC. All samples were sent for histology, and the results were compared.

Result

Of the 300 women, 103, 100 and 97 had ECC with curette, brush and curette and brush, respectively. Samples were adequate in 92 (89.3%) of the curette, 69 (69.0%) of the brush and 78 (80.4%) of the curette and brush groups. The curette and curette and brush yielded more samples (p = 0.00) and (p = 0.04), respectively, compared with the brush, but there was no difference in yield between curette and curette and brush (p = 0.06). However, there was no difference in the yield of CIN2+ between the sampling devices. Age and parity had no effect on the sample adequacy by the different devices.

Conclusion

Curette and the curette and brush yielded more samples compared with the brush alone. However, CIN2+ pick-up was similar across all sampling devices.

Diagnostic Three Slides Pap Test Compared to Punch Biopsy and Endocervical Curettage in Confirmed HSIL+ Diagnosis

Objective: The aim of the study was to evaluate the accuracy of the diagnostic Pap test (DPT) on three slides and punch biopsy and endocervical curettage (PB/ECC) compared with the final biopsy material in the detection of high-grade squamous intraepithelial lesion (HSIL). Materials and methods: Patients treated with conization after previous DPT and PB/ECC were analyzed. The findings of the DPT and PB/ECC as well as of the endocervical brush cytology and ECC were compared with the final conus histology. Results: 150 patients were analyzed, and final histology verified 145 cases of HSIL and 3 cancers. The percentage of confirmed HSIL cytology was 97%, while for PB/ECC it was 79% with 30/145 false negative results. The correlation between Pap test and PB/ECC showed that the diagnostic accuracy of DPT is significantly higher (p < 0.0001). Endocervical brush cytology confirmed HSIL+ in the endocervical canal in 83% and ECC in 35% of cases (p < 0.0001). Conclusion: The DPT on three slides enables better detection of HSIL compared to PB/ECC, particularly for lesions localized in the endocervical canal sampled with a cytobrush. A high quality DPT could represent a surrogate for PB/ECC and open the possibility of direct access to therapeutic procedure.