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ECC at LLETZ-An Exploratory Retrospective Cohort Study.

Chiara Paternostro1, Elmar A Joura1, Johannes Ott2

  • 1Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, 1090 Vienna, Austria.

Journal of Clinical Medicine
|November 27, 2024
PubMed
Summary

Endocervical curettage (ECC) after large loop excision of the transformation zone (LLETZ) rarely provides additional diagnostic information. Its routine use is questionable, as HPV testing is a more reliable indicator of treatment success.

Keywords:
ECCHSILLLETZadequacyhigh-risk HPVmargin statussquamous epithelial cellstransformation zone

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Area of Science:

  • Gynecologic Oncology
  • Cervical Pathology

Background:

  • Evaluating the utility of endocervical curettage (ECC) alongside large loop excision of the transformation zone (LLETZ).
  • Assessing the diagnostic value of ECC for detecting precancerous lesions above LLETZ margins.
  • Addressing the limited data on ECC's predictive value and accuracy in this context.

Purpose of the Study:

  • To determine the distribution of histological findings from ECC performed after LLETZ.
  • To evaluate the additional diagnostic information provided by ECC.
  • To assess the impact of ECC results on subsequent clinical treatment decisions.

Main Methods:

  • Retrospective cohort study of 1121 patients undergoing LLETZ and ECC from 2009-2021.
  • Analysis of main outcome parameters: histological diagnosis and specimen adequacy.
  • Evaluation of ECC's impact on therapeutic approach and detection of residual disease.

Main Results:

  • ECC yielded additional diagnostic information in only 1.7% of cases.
  • ECC results influenced subsequent treatment in 0.2% of patients.
  • A negative ECC showed a low negative predictive value (43.8%) for residual disease detection.

Conclusions:

  • Routine ECC performance at the time of LLETZ is questionable.
  • Current guidelines favor HPV testing post-LLETZ for treatment success assessment.
  • The added diagnostic yield of ECC does not consistently justify its routine use.