Endocervical curettage (ECC) is a common, minimally invasive diagnostic procedure used to investigate the health of the cervical canal. This technique involves collecting tissue from the inside lining of the cervix, the lower, narrow part of the uterus that opens into the vagina. ECC is performed when a physician needs a more detailed cellular analysis than a standard cervical screening test, such as a Pap smear. The tissue sample obtained is sent to a laboratory for microscopic examination to check for abnormal cells or disease.
Defining Endocervical Curettage
The cervix is anatomically divided into two main parts: the ectocervix and the endocervix. The ectocervix is the outer portion visible from the vagina, while the endocervix is the lining of the cervical canal, the passageway that connects the vagina to the uterine cavity. Endocervical curettage specifically targets the tissue within this canal, which is often out of reach for a typical Pap smear.
During the procedure, a specialized, small, spoon-shaped instrument called a curette is gently inserted into the cervical canal. The physician uses the curette to carefully scrape a thin layer of the mucous membrane, collecting cells and underlying tissue. This action obtains a sample of the glandular cells lining the endocervical canal for histopathological study. The collected tissue is then preserved and prepared for a pathologist to analyze under a microscope.
Diagnostic Reasons for ECC
A physician typically orders an ECC when previous screening tests suggest a need for deeper investigation into the cervical canal. One of the primary indications is the evaluation of abnormal glandular cells identified on a Pap smear. Because these cells originate from the inner canal, the ECC provides the necessary tissue sample to determine the nature of the abnormality.
The procedure is also performed to investigate unexplained or persistent abnormal uterine bleeding. Abnormal bleeding can be a symptom of conditions originating in the endocervix, and tissue analysis helps identify the underlying cause, such as polyps or atypical cell growth. ECC is often paired with a colposcopy when the squamocolumnar junction—the area where the outer and inner cervical linings meet—cannot be fully visualized. This ensures that potential precancerous or cancerous changes high up in the canal are not missed.
Patient Preparation and Procedure Steps
Preparation for endocervical curettage ensures the sample is clear and accurate. Patients are advised to schedule the procedure when they are not actively menstruating, as blood can interfere with analysis. To prevent contamination of the tissue sample, patients must refrain from douching, using tampons, or having sexual intercourse for at least 24 hours before the appointment.
The procedure is usually performed in an outpatient setting. The patient is positioned on an examination table, similar to a standard pelvic exam, and a speculum is inserted into the vagina to hold the walls apart and allow the physician to visualize the cervix. The area is then cleansed with a sterile solution, and sometimes a tool called a tenaculum is used to gently stabilize the cervix.
A local anesthetic may be administered to minimize discomfort, though some practitioners suggest taking an over-the-counter pain reliever beforehand to manage potential cramping. The curette is then introduced into the cervical canal, and the physician rotates it to scrape the lining and collect the tissue sample. The entire process is brief, typically lasting only a few minutes. Afterward, the collected tissue is immediately placed in a preservative solution and sent to the pathology laboratory.
Recovery and Understanding the Results
Following an endocervical curettage, patients can typically return to most normal activities within a day, though mild cramping is common. It is normal to experience light bleeding or spotting for a few days after the procedure. To support healing and reduce the risk of infection, patients are usually instructed to avoid placing anything into the vagina, such as tampons or douches, and to abstain from sexual intercourse for a short period, often one to two weeks.
The pathology report typically takes between one and two weeks to be finalized. The report classifies the tissue findings, which may indicate inflammation or various degrees of abnormal cell changes, such as dysplasia. These abnormalities are categorized using systems that describe precancerous changes. The physician will then schedule a follow-up consultation to interpret the specific findings and discuss whether further monitoring or treatment is necessary.