Diagnostic accuracy of two endocervical sampling method: randomized controlled trial

To compare the diagnostic accuracy of endocervical curettage (ECC) and endocervical brushing (EB) in patients referred for colposcopic evaluation for low grade squamous intraepithelial lesion.

A prospective, randomized, comparative trial was conducted in an Education and Research Hospital, Gynecologic Oncology Clinic. After exclusion of 40 subjects, 208 patients were randomly allocated into ECC (n = 104) and EB (n = 104) groups. A pathologist blinded to the specimen obtaining method evaluated all samples for the primary outcome of sampling adequacy. Secondary outcome measure was pain scores during the sampling was investigated by using visual analogue scale (VAS).

Ten samples from the ECC group (9.6 %) and 12 samples from the brushing group (12 %) contained scanty endocervical specimen (p = 0.09). Evaluating samples for stroma; it was reported that brushing group had a statistically significantly higher percentage of specimens with no stroma (44 %) than ECC group (24 %) (p = 0.003). Mean and standard deviation of VAS scores during the ECC and EB procedures were 2.55 ± 1.12 and 1.99 ± 0.87, respectively (p < 0.001).

Endocervical brushing was proved to be as accurate with respect to diagnostic yield as ECC but less painful, evaluating the endocervical canal. It can be an alternative for evaluation of the cervical canal pathology in patients with low grade cytologic abnormalities but devoid of the misinterpretation of stromal invasion; ECC should be preferred in patients with a suspicion of invasive disease.