Comparing Endocervical Curettage and Endocervical Brush at Colposcopy

abstract & commentary

Source: Dunn TS, et al. J Lower Genital Tract D 2000;4:76-78.

Synopsis: The endocervical brush can be used in place of the endocervical curettage to evaluate the endocervix.

Evaluation of the endocervix is a routine part of the practice of colposcopy. In the past, either an endocervical curettage (ECC) or visualization of the entire transformation zone on the portio of the cervix were the most common methods to perform this evaluation. Several papers have now been published that have shown that the ECC has low sensitivity for the detection of disease in the canal (many "false negatives") and that the endocervical brush (ECB) misses far less disease. On the other hand, there are more "false positives" with the ECB.

In order to study which technique is superior, Dunn and colleagues reviewed the charts of 369 consecutive patients referred for colposcopic examination. All patients had an ECB sample taken before colposcopy and an ECC performed at the end of the procedure. Those 105 women who had cervical conization (either by scalpel or loop excision) served as the study sample.

The results of this review showed that the ECB was considerably more sensitive than the ECC for the detection of endocervical disease, but that the specificity was lower. The ECC missed 38% of the endocervical neoplasia that was present in the cone specimen while the ECB missed only 7%. These findings are similar to other studies.

COMMENT BY KENNETH L. NOLLER, MD

This is certainly not the first study to compare ECC to the brush. I have previously reviewed at least some of these articles and have written one editorial about them. Why then would I abstract yet another paper on the same subject?

The answer lies in the fact that, despite multiple articles showing that ECC misses more disease than the brush, the ECC remains a routine part of many colposcopic examinations. When I ask "Why?" the usual response is either, "That’s the way I learned" or "I don’t want to be sued."

Medicine is an ever-changing field. We must learn from the literature and change the way we do things. In my view, there is now ample evidence to state that the brush is superior to the ECC and the latter abandoned (with the possible exception of the evaluation of an AGUS smear). Likewise, the data are so convincing that I would worry more about being sued if I used a technique (ECC) that has been shown to miss up to 50% of the disease it is supposed to detect than using a technique (brush) that has been shown to be more sensitive.