ABSTRACT
Background: Endocervical curettage (ECC) specimens routinely aid in diagnosis of cervical dysplasia. At our institution, we routinely use the words insufficient or scant/minute to convey inadequacy and under-sampling of a ECC specimen. Among patients with an inadequate ECC, conclusions are not possible in absence of a positive concurrent cervical biopsy (CCB). Though a repeat procedure is recommended for patients with inconclusive results, many are not followed in a timely fashion. The goals of this work are to identify predictors of follow-up within one year among patients with tissue-poor ECC, and to characterize the frequency of non-benign outcomes on repeat procedures among such patients for whom a follow-up procedure was actually performed. Design: We identified ECC specimens reported as insufficient or scant/minute in our pathology data system from April to September in 2018 and 2020. Age;HPV status;concurrent cervical biopsy;prior history of ASCUS, LSIL, and HSIL;and pathologic findings on follow-up procedures (if performed) were recorded. We used multivariate logistic regression to identify predictors of follow-up among patients with either no CCB performed or a benign CCB. Results: We identified 294 patients with inadequate ECC specimens. The mean age was 41.5 years (SD=12.3). A total of 173/294 (59%) patients had a CCB;64/173 (37%) had LSIL and 27/173 (16%) had HSIL. Among the 83 patients with a benign CCB, 51 (61%) were followed, and 12/51 (24%) had dysplasia/carcinoma reported on their follow up procedure. Among the 121 patients with no CCB, 68 (56%) were followed, and 22/68 (32%) had dysplasia/carcinoma reported on a follow up procedure. We identified HPV18 (aOR=6.3, 95% CI: [1.5, 26.3];p=0.01), prior HSIL (aOR=3.3, 95% CI: [1.2, 9.4];p=0.02), and prior ASCUS (aOR=2.1, 95% CI: [1.04, 4.1];p=0.04) as significant predictors of receiving a follow up procedure on an inadequate ECC. We further found that follow up was markedly lower during the COVID-19 pandemic (aOR=0.24, 95% CI: [0.12, 0.42];p<0.001). Additional odds ratios are reported in Table 1. Conclusions: The high rate of non-benign results on follow-up sampling to inconclusive prior results is alarming and critically important. This study highlights the need for more effective diagnostic verbiage on inadequate / poorly sampled ECC specimens, to ensure adequate follow-up. This study also supports the hypothesis that the COVID-19 pandemic has had an adverse role in longterm cancer prevention.