Comparison of Sampling Devices for Endocervical Curetting

Endocervical curetting (ECC) is mandatory when colposcopy is inadequate or when the Pap smear suggests glandular lesion. When the curette is used, ECC is painful; this necessitated the development of the endocervical brush. There is no consensus on which device yields more sample, detects true cervical precancer (CIN2+) better or highlights the effects of age and parity on ECC yield.

To compare ECC yield and the ability to pick up CIN2+ by the different devices and effect of parity and age on yield.

Three hundred women referred for colposcopy following positive cervical high-risk HPV DNA test who had inadequate colposcopic examination were randomly allocated to curette, brush and curette and brush groups for ECC. All samples were sent for histology, and the results were compared.

Of the 300 women, 103, 100 and 97 had ECC with curette, brush and curette and brush, respectively. Samples were adequate in 92 (89.3%) of the curette, 69 (69.0%) of the brush and 78 (80.4%) of the curette and brush groups. The curette and curette and brush yielded more samples (p = 0.00) and (p = 0.04), respectively, compared with the brush, but there was no difference in yield between curette and curette and brush (p = 0.06). However, there was no difference in the yield of CIN2+ between the sampling devices. Age and parity had no effect on the sample adequacy by the different devices.

Curette and the curette and brush yielded more samples compared with the brush alone. However, CIN2+ pick-up was similar across all sampling devices.