| Endocervical curettage | |
| Purpose: | test for abnormal, precancerous condition |
Endocervical curettage (ECC) is a procedure in which the mucous membrane of the cervical canal is scraped using a spoon-shaped instrument called a curette. The procedure is used to test for abnormal, precancerous conditions, or cervical cancer.[1] The procedure is generally performed after an abnormal pap smear to further assess the tissue. Other common indications to perform ECC include evaluation of persistent HPV infections, workup of unexplained abnormal uterine bleeding, and follow up of inconclusive colposcopy.
ECC is a medical procedure used to extract cells of the endocervix to visualize under a microscope. Direct cervical visualization, colposcopy, and even endocervical colposcopy are not enough to fully analyze all areas of the endocervical epithelium and thus ECC is the method of choice in cases where this is necessary.
Generally the next step in workup of an abnormal pap smear includes a colposcopy which involves the direct visualization of the cervix. However, the cervical epithelium of the endocervix cannot be visualized and ECC may be used to biopsy the endocervix epithelium. ECC is particularly useful in cases of colposcopy where the squamocolumnar junction (SCJ) is not visualized.[2]
The indications to perform endocervical curettage vary by society recommendations but some commonly accepted indications include:
Endocervical curettage is performed with a curette which is used to scrape cells from endocervical canal. The curette is advised to be firmly held like a pen, and should scrape the endocervical canal in small strokes. The curette should be carefully removed from the canal once the entire area is sampled so the sample is not lost. These biopsied cells should be immediately placed into formalin, are they are later viewed under a microscope by a pathologist to assess for any abnormalities.[4]
Guidelines reveal good evidence that ECC is contraindicated in pregnancy. There is a risk of damage to fetal membranes or placenta along with an increased risk of cervical perforation due to the softening of the cervix during pregnancy. For these reasons, pregnancy is a well established contraindication to performing ECC.
Other risks include bleeding, infection, and pain.