Positive endocervical curettage in patients with satisfactory and unsatisfactory colposcopy: clinical implications.

We studied a total of 177 patients with cervical intraepithelial neoplasia or invasive carcinoma to evaluate the clinical implications of a positive endocervical curettage. All patients underwent cervical conization. One hundred and ten women had unsatisfactory colposcopy; 67 had satisfactory colposcopy. Patients with unsatisfactory colposcopy had a higher frequency of invasive lesions in the endocervix (9 versus 1.5%, P less than .05) and involvement of internal cone margins (12 versus 0%, P less than .01); they were also more likely to require additional, frequent treatment for persistent or recurrent disease (9 versus 1%, P less than .05) than patients with satisfactory colposcopy. Histologic review of the cone specimens in patients with satisfactory colposcopy revealed no lesion deeper in the endocervical canal than was predicted by colposcopic examination. These observations suggest that selected patients with positive endocervical curettage may be managed without diagnostic conization, if they had a satisfactory colposcopic examination.