An endocervical curettage is a procedure performed after abnormal results from a Pap test. A sample of tissue is taken from the lining of the cervical canal, using a curette, a spoon-shaped tool. The tissue sample is taken to a lab to be checked under a microscope to determine if there is any indication of disease. 

This article discusses why you may need an endocervical curettage, the procedure, risks, and how to interpret the results.

Why You May Need an Endocervical Curettage

An endocervical curettage has been increasingly used in colposcopy/biopsy exams each year in the United States in approximately three million women who have had abnormal Pap tests and require colposcopies.  

Studies show that colposcopy biopsies may not detect 30% to 50% of common high-grade cervical precancers. For better accuracy in detecting cervical precancers, medical experts recommend taking multiple lesion-directed biopsies and endocervical curettage.

If any abnormalities turn up in your Pap test or if a positive test indicates the presence of high risk human papillomavirus (HPV), your gynecologist may recommend a colposcopy, which may include a cervical biopsy that may be a:

  • Punch biopsy that uses a device that “punches” out a sample of tissue
  • Cone biopsy that removes a cone-shaped piece of tissue
  • Endocervical curettage that uses a spoon-like tool to scrape the lining of the cervical canal

Once the sample is taken to the lab, the results may show precancerous changes on the cervix that may indicate an HPV infection, which can increase the risk for cervical cancer, and diethylstilbestrol (DES) exposure if your mother took DES when pregnant. DES, a synthetic form of estrogen (no longer prescribed), raises the risk for cancer of the reproductive system.  

How to Prepare for an Endocervical Curettage

After you receive the results of your Pap test, your gynecologist will explain what follows if the lab results showed any abnormalities. They will discuss the procedure and answer any questions you may have.

If you are pregnant or think you’re pregnant, inform your doctor. Also tell your doctor:

  • If you have any bleeding disorders and if you take anticoagulants, aspirin, or other medication that affects blood clottingIf you have allergies to medication, types of anesthetics, and latex, or certain tapesIf you take any medication, whether it’s prescribed or over-the-counter

Avoid having sex, using tampons, vaginal creams or medicines, and douching for 24 hours prior to the procedure. 

Your healthcare provider may suggest that you take a pain reliever 30 minutes before the procedure or your doctor may give you medicine to help you relax. If anesthesia is used, you will need someone to drive you home afterwards. There may be some bleeding so make sure to bring a sanitary pad to wear home. 

What to Expect During and After

Typically an endocervical curettage is done in the healthcare provider’s office but if it is accompanied by a LEEP procedure or cone biopsy, it may be done at the hospital or an outpatient facility. You are not usually given anesthesia in the office but if you are in the hospital you will likely be given anesthesia, and you may be either awake or asleep during the entire procedure.

Like a pelvic exam, a speculum with be inserted into your vagina so that your healthcare provider has a better view of your cervix and will proceed to clean the area with a solution of either vinegar or iodine, which may burn or sting.

To hold the cervix in place, your doctor may use tenaculum, a slender, sharp-pointed hook with a handle used for grasping and holding parts used in surgery. With the curette inserted in the cervical canal, your healthcare provider will scrape a thin layer of tissue. Once the tissue is removed it will be sent to a lab to determine if there are any abnormalities, like cancer. 

Once the procedure is completed, you may have some spotting and also some discharge from the solution used. Your healthcare provider may recommend that you don’t insert anything in the vagina and abstain from sexual intercourse for at least 48 hours.

Risks

Like many medical procedures there are a few risks that may include:

  • BleedingInfectionInjury to the cervixTear in the uterus

Possible infection may require antibiotic treatments with a possible stay in the hospital. Cervical injury may require surgery.

If you experience any heavy bleeding, pelvic pain, fever, or foul-smelling discharge, call your healthcare provider immediately.

Interpreting the Results

Tissue taken from endocervical curettage may show abnormal changes to the cells in the cervix. The lab will use the Bethesda reporting system that provides a breakdown of grades of abnormal cells from normal cells. This system includes the designation of low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL) and adenocarcinoma in situ (AIS). Other systems refer to cervical intraepithelial neoplasia (CIN) and cervical dysplasia.

Abnormal Squamous Cells

Abnormal squamous cells are classified as squamous intraepithelial lesion (SIL) and are either low grade or high grade:

  • Low-grade SIL (LSIL) compares to CIN 1 and mild dysplasia. LSIL affects a lower part of the cervical liningHigh-grade SIL (HSIL) compares to CIN 2 and CIN 3 and moderate and severe dysplasia. HSIL affects most of the cervical lining

Cervical intraepithelial neoplasia (CIN) can also describe abnormal changes to squamous cells in the cervix. Neoplasia is an abnormal and uncontrolled growth of cells.

CIN is graded 1 to 3 based on how abnormal the cervical tissue looks under a microscope:

  • CIN 1 is the least severe and compares to mild dysplasia.CIN 2 is moderately severe and compares to moderate dysplasia.CIN 3 is the most severe. It describes both severe dysplasia and carcinoma in situ (a very early stage of cancer in which tumor cells have not yet invaded surrounding tissues).

Dysplasia means that cells are different from normal cells in size, shape, and organization within tissue. Dysplasia usually refers to a precancerous condition and categorized as: 

  • Cells look slightly different from normal cells with mild dysplasiaCells look quite different from normal cells with moderate dysplasia Cells look very different from normal cells with severe dysplasia

Adenocarcinoma in situ (AIS) are cancer cells found in the glandular tissue of the endocervix. The cancer hasn’t spread into the deeper tissues of the cervix or surrounding tissue.

Next Steps

Once your healthcare provider has received the lab results, he will contact you and discuss treatment options. Depending on the severity of the diagnosis, some changes in the cells may not need any type of treatment. In some cases abnormal cells can change back to normal on their own, while other abnormal cells or precancerous changes to cells may develop into cancer if they aren’t treated.

Summary

Endocervical curettage is a procedure used after you receive the results of an abnormal Pap test. The procedure involves taking tissue sample from the cervical canal’s wall, using a curette, an instrument shaped like a spoon. Once your healthcare provider has the tissue sample, it will be sent to a lab to be examined under a microscope to determine if there is any indication of disease. If there is disease, your healthcare provider will let you know the next steps.

A Word from Verywell

An endocervical curettage is another biopsy procedure used after you receive the results of an abnormal Pap exam. While receiving news of a questionable Pap test can cause anxiety, be aware that many conditions are treatable, including cervical cancer, when you receive an early diagnosis and receive prompt treatment.