To assess the role of routine endocervical curettage (ECC) and additional excisional biopsies (eg, top hat) performed with loop electrosurgical excisional procedure (LEEP) in the management of severe cervical dysplasia.METHODS:
Clinicopathologic data were abstracted from all patients who underwent LEEP for high grade dysplasia (CIN2-3) within a safety net health system between 2001 and 2013. Persistent disease was defined as uninterrupted abnormal cervical cytology following LEEP, whereas recurrent disease was defined as dysplasia ≥1 year after LEEP with intervening normal cytology. Chi-square, Fisher's exact test and logistic regression were used to examine associations between demographic features, histologic parameters and clinical outcomes.RESULTS:
A total of 606 women underwent LEEP, of which 178 (29%) were evaluated by ECC, while 80 (13%) received a top hat and 99 (16%) underwent both procedures. With mean follow-up of 1.9+1.5 years, persistent dysplasia was identified in 131 women (22%) and recurrent disease in 31 (5%). The presence of dysplasia on ECC performed either with LEEP (OR= 3.3, 95% Cl 1.3–8.4, P=.01) or with the colposcopy preceding LEEP (OR=1.81, 95% Cl 1.2–2.8, P=.004) correlated with the likelihood of persistent but not recurrent dysplasia. The presence of dysplasia on ECC specimens obtained after LEEP with top hat was also predictive of recurrent dysplasia. However, no correlation between top hat results and persistent or recurrent dysplasia were identified.CONCLUSION:
ECC is preferable to top hat for predicting persistent cervical dysplasia and may play an important role in detecting skip lesions responsible for recurrent disease.