Routine endometrial curettage is not indicated at the time of cervical cone biopsy

Endometrial currettage is commonly performed after cervical cone biopsy to detect occult endometrial abnormalities. Recently, this practice has been questioned and specific criteria promulgated to reduce the number of concomitant endometrial curettages performed at the time of cone biopsy. To investigate the reliability of these criteria, we reviewed the records of 370 women who underwent cold-knife cervical cone biopsy, 323 (87.3 percent) of whom underwent concomitant endometrial curettage. Significant endometrial abnormalities were present in only 18 women, each of whom met at least one specific criterion for endometrial currettage. In contrast, 23 endometrial currettings either contained cervical tissue (five patients) or were insufficient for diagnosis (18 patients). The incidence of complications directly attributable to endometrial curettage was 1.6 percent. We conclude that limiting endometrial curettage at the time of cone biopsy to those women meeting specific criteria would significantly reduce the number of endometrial currettings performed, without hindering the ability to detect significant endometrial abnormalities. Such a reduction would minimize surgical morbidity and could save $13 million annually in the United States.