What Is Endocervical Curettage and When Is It Needed?

Endocervical curettage, usually shortened to ECC, is a quick scraping of cells from the narrow canal inside your cervix. It is usually done during the same visit as a colposcopy, because precancer can hide in that canal, where a doctor’s magnifying view can’t reach.1Journal of Lower Genital Tract Disease. Colposcopy Standards: Guidelines for Endocervical Curettage at Colposcopy It isn’t routine for everyone: doctors add it when your results or history make hidden disease more likely, and they skip it during pregnancy.2Journal of Lower Genital Tract Disease. Colposcopy Standards: Guidelines for Endocervical Curettage at Colposcopy

What Happens During Endocervical Curettage

Once the colposcopy look is done, the doctor places a thin, sharp, spoon-like tool called a curette inside the cervical canal.3PubMed Central. Diagnosis of Cervical Precancers by Endocervical Curettage at Colposcopy of Women With Abnormal Cervical Cytology They move it back and forth and rotate it so it scrapes the whole circle of the canal.4PubMed Central. Colposcopy Standards: Guidelines for Endocervical Curettage at Colposcopy The aim is to keep the tool inside the canal so cells from the outer cervix don’t mix in.5PubMed Central. Diagnosis of Cervical Precancers by Endocervical Curettage at Colposcopy of Women With Abnormal Cervical Cytology A quick spin as the tool comes out traps the cells, and small forceps may pick up any left behind.6PubMed Central. Diagnosis of Cervical Precancers by Endocervical Curettage at Colposcopy of Women With Abnormal Cervical Cytology Some doctors use a small brush instead of a curette.7PubMed. Comparison of endocervical curettage and endocervical brushing

The scraping itself usually lasts well under a minute. Many people feel a sharp cramp, similar to a period cramp, while it happens. It is often done right before or after small biopsies of the outer cervix at the same visit.

ECC is different from a regular biopsy. A punch biopsy takes a small piece from a spot the doctor can see on the outer cervix. ECC samples the canal blindly, collecting cells from all around rather than from one visible spot. An endometrial biopsy is another test entirely: it samples the lining of the uterus, deeper inside, and is used for abnormal bleeding.

The sample goes to the lab in its own labeled container, separate from the cervical biopsies, so the pathologist knows which part of the cervix each sample came from. The cells arrive as small fragments and mucus rather than a neat piece of tissue, which is normal for this kind of sample.

When Doctors Recommend Endocervical Curettage

Cervical changes usually begin where the outer cervix meets the canal, an area your report may call the transformation zone. When that meeting line sits up inside the canal, the colposcope can’t fully see it.8Journal of Lower Genital Tract Disease. Colposcopy Standards: Guidelines for Endocervical Curettage at Colposcopy ECC is recommended whenever the doctor can’t see that line all the way around.9Journal of Lower Genital Tract Disease. Colposcopy Standards: Guidelines for Endocervical Curettage at Colposcopy In cases where the zone was hidden, high-grade precancer and even cancer turned up in women whose Pap results were normal or only mildly abnormal.10PubMed Central. Evaluation of endocervical curettage (ECC) in colposcopy for detecting cervical intraepithelial lesions

Guidelines also recommend ECC in these situations:

Age 40 is a reason to add ECC, but being younger doesn’t rule it out when other factors on the list apply. Your doctor weighs your age together with your Pap result, HPV type, and what the colposcopy showed.

ECC should never be done during pregnancy, because the softened cervix and the risk to the membranes and placenta could cause pregnancy loss.17Journal of Lower Genital Tract Disease. Colposcopy Standards: Guidelines for Endocervical Curettage at Colposcopy It can also be skipped when a procedure to remove part of the cervix is already planned, or when the canal is too narrow for the tool.18Journal of Lower Genital Tract Disease. Colposcopy Standards: Guidelines for Endocervical Curettage at Colposcopy It can be skipped for women under 30 who have never given birth and have only mild Pap changes.19Journal of Lower Genital Tract Disease. Colposcopy Standards: Guidelines for Endocervical Curettage at Colposcopy Even so, guidelines still allow it for any non-pregnant patient when the doctor thinks it’s worthwhile.20Journal of Lower Genital Tract Disease. Colposcopy Standards: Guidelines for Endocervical Curettage at Colposcopy If you don’t fit the list, it’s reasonable to ask, “Why are you doing ECC in my case?”

If there’s any chance you’re pregnant, say so before the visit or before the speculum goes in. A pregnancy test may be done first. Colposcopy can still be done in pregnancy, just without the canal scraping.

Does Endocervical Curettage Hurt

People tend to rate the canal scraping as more painful than the cervical biopsies in the same visit.21PubMed. Local anesthetic reduces the pain of colposcopic biopsies: a randomized trial The biopsy of the outer cervix often feels like a quick pinch, while the scraping tends to feel like a deeper, crampy ache, partly because the tool works deeper inside the canal.

There are ways to lower it. A numbing injection of lidocaine into the cervix lowered pain from the scraping by about a third.22PubMed. Local anesthetic reduces the pain of colposcopic biopsies: a randomized trial In one study, lidocaine given by IV alongside anti-inflammatory pain relievers lowered pain during biopsy and ECC.23Ginekologia Polska. Does intravenous lidocaine added to nonsteroidal anti-inflammatory drugs reduce pain during colposcopy? A prospective randomized double-blind study Using a brush in place of the curette was somewhat less painful in one trial,24PubMed. Diagnostic accuracy of two endocervical sampling method: randomized controlled trial though another comparison found no clear difference in pain between brush and curette.25PubMed. Comparison of endocervical curettage and endocervical brushing

Some preparation helps too. Ask ahead whether numbing medicine is offered at your clinic, and whether taking ibuprofen about an hour before is okay for you. Anxiety can tighten the pelvic muscles and make the cramp feel stronger, so slow breathing during the scrape helps them relax. If you need a pause, say so; the scrape can wait a moment.

Afterward, expect mild period-like cramps that can last a few hours. Over-the-counter pain relievers usually manage them. Severe or worsening pain is not expected and is worth a call.

Recovery and Risks After Endocervical Curettage

Possible complications include injury to the cervix, infection, and bleeding, but heavy bleeding is rare.26All About Women MD. Endocervical Curettage for Women: Risks, Recovery & Why It’s Necessary Light spotting is expected after ECC and biopsies and usually fades within a few days. It should get gradually lighter, not heavier, as days pass. A thin pinkish or watery discharge is also common while the cervix heals. Brown, coffee-ground-looking discharge is common for a few days after colposcopy, especially when a paste is used to stop bleeding.

In the first days, use pads rather than tampons. Many doctors advise avoiding sex and douching for a few days, or as you’re told. You can usually return to work the same day.

Call your doctor if you have bleeding heavier than a period or soaking a pad in an hour, fever or chills, foul-smelling discharge, or pelvic pain that grows worse instead of easing.

What Your Endocervical Curettage Results Mean

In one large study of people having colposcopy, ECC found high-grade precancer in about 12 in 100.27PubMed Central. Yield of endocervical curettage in detecting cervical intraepithelial neoplasia grade 2 or higher during colposcopy: A prospective, cross‐sectional study In only about 3 in 100 was ECC the thing that caught a precancer the biopsies missed.28PubMed Central. Yield of endocervical curettage in detecting cervical intraepithelial neoplasia grade 2 or higher during colposcopy: A prospective, cross‐sectional study Among women with atypical glandular cells on Pap, ECC alone found high-grade disease in about 1 in 100, rising to about 7 in 100 in those with HPV 16 or 18.29PubMed Central. The value of endocervical curettage for diagnosis of cervical precancers or worse at colposcopy of women with atypical glandular cells cytology

Results usually take one to two weeks. On the report, “negative” or “benign endocervical tissue” means no abnormal cells were seen. “CIN2,” “CIN3,” or “HSIL” means high-grade precancer that usually needs treatment. “AIS” means glandular precancer inside the canal. “Scant” means few cells; ask whether a repeat is planned. “Scant” is not the same as negative.

A negative result is fairly reassuring but not a guarantee. In postmenopausal women with persistent high-risk HPV and a hidden transformation zone, a negative ECC was right almost 9 times in 10.30PubMed Central. Role of endocervical curettage in detecting CIN2 + in postmenopausal women with persistent high-risk HPV and type 3 transformation zone Because the scraping is done blindly, it can miss a small patch of abnormal cells the curette didn’t touch.

A positive result is less certain than it sounds. In that same group of women, a positive ECC was confirmed only a little over half the time.31PubMed Central. Role of endocervical curettage in detecting CIN2 + in postmenopausal women with persistent high-risk HPV and type 3 transformation zone Cells from a lesion near the canal’s opening can get into the sample and make it look positive.32PubMed. Comparison of endocervical curettage and endocervical brushing A positive ECC means abnormal cells were found, but not exactly where they came from or how far they extend. It usually leads to more testing or treatment rather than a final diagnosis.

Sometimes the report says the sample was scant or too small to judge.33PubMed. Adequacy in Endocervical Curettage Samples showing high-grade disease tend to contain far more cells than negative ones,34PubMed. Adequacy in Endocervical Curettage but a small sample isn’t itself a sign of a normal result. Also, pathologists don’t need a set number of cells from the transformation zone to count a sample as adequate.35PubMed. Presence of 10 transformation zone cells in endocervical curettage should not be required for adequacy

Next Steps After an Abnormal Result

High-grade precancer is commonly treated with LEEP (loop electrosurgical excision procedure), which removes a small cone of tissue with a thin electrified wire loop. It is usually done in the office with a numbing injection into the cervix, so you stay awake but should feel little pain. The loop is passed through the abnormal area, cutting out a thin cone-shaped piece and sealing blood vessels with heat as it goes. The procedure itself takes only a few minutes, though the whole visit is longer. The tissue goes to the lab, which checks both the abnormal cells and whether they reach the edges of the sample.

A cone procedure removes a cone-shaped piece of cervix too, but it is sometimes done with a scalpel or laser in an operating room. It is more often used when a larger or deeper piece is needed, such as for glandular precancer, because it can take a single intact specimen. It more often involves sedation or anesthesia. Your doctor picks between the two based on the type and location of the abnormal cells.

Glandular findings are handled more cautiously. If biopsy shows glandular precancer (AIS), a removal procedure is recommended because about 15 in 100 such cases already hide an early cancer.36PubMed Central. Diagnosis and Management of Adenocarcinoma in Situ A removal procedure is also advised when glandular-cell Pap results persist but biopsy and ECC are both negative.37PubMed Central. Diagnosis and Management of Adenocarcinoma in Situ For glandular precancer, a negative ECC and clean edges were not reliable signs the disease was gone.38PubMed. Endocervical curettage, cone margins, and residual adenocarcinoma in situ of the cervix

Doctors may scrape the remaining canal right after removing the cone of tissue.39American Society for Colposcopy and Cervical Pathology. What Are ASCCP Practice Pearls? | Expert Guidance for Cervical Cancer Management A positive ECC at that point was the strongest sign that precancer would persist or return, even more than the cone’s edges.40PubMed. The value of endocervical curettage during loop electrosurgical excision procedures in predicting persistent/recurrent preinvasive cervical disease Repeat ECC in follow-up visits can catch early returns, especially in people with positive edges or ongoing HPV.41PubMed. Value of endocervical curettage in follow-up for patients with cervical intraepithelial neoplasia stage 2+ after loop electrosurgical excision

After treatment, expect repeat HPV and Pap testing over the next years. ECC may be part of these visits because treatment can hide the canal. Risk stays raised for decades, so don’t skip follow-ups.

After a positive result, it helps to ask whether the precancer is squamous or glandular, whether you need treatment or it can be watched, and how treatment might affect future pregnancy.

Brush or Curette Which Works Better

A brush and a curette gave a usable diagnosis equally often, about 96 to 98 times in 100.42PubMed. Endocervical sampling using brush versus curette: a single centre experience and literature review Both found high-grade disease at similar rates when combined with biopsies.43PubMed. Endocervical sampling using brush versus curette: a single centre experience and literature review Both methods also gave a false alarm in roughly 3 in 10 abnormal samples, from cells near the opening.44PubMed. Comparison of endocervical curettage and endocervical brushing

The difference is in the tissue. The cytobrush is a small bristled brush, similar to the type used in a Pap test, placed in the canal and rotated to pick up cells. Its bristles gently sweep the surface rather than scrape, so it collects mainly surface cells. The cells are then rinsed into liquid or smeared on a slide for the lab. Brush samples more often lacked the deeper tissue layer pathologists like to see.45PubMed. Diagnostic accuracy of two endocervical sampling method: randomized controlled trial Pathologists want the full thickness of the canal lining because it shows how cells are arranged, which helps tell abnormal from normal.

If pain worries you, ask whether a brush is an option.