An Endocervical Curettage (ECC) is a common diagnostic procedure used in gynecology to collect a tissue sample from the endocervical canal, which is the inner passageway of the cervix that connects the vagina to the uterus. The primary goal of an ECC is to detect any abnormal, pre-cancerous, or cancerous changes that are not visible on the outer surface of the cervix or are otherwise missed by a standard Pap smear. The analysis of this collected tissue provides clinicians with definitive information about the health of the cervical lining, guiding necessary follow-up care and treatment decisions.
Clinical Reasons for Endocervical Curettage
A gynecologist typically recommends an ECC when previous screening results suggest the possibility of abnormalities deeper within the cervical canal. One of the most frequent reasons is an abnormal Pap test, particularly when the results point toward atypical glandular cells or high-grade cellular changes that require further investigation. The ECC is especially important when a visual examination of the cervix, known as a colposcopy, cannot fully see the transformation zone, which is the area where most pre-cancers begin.
The procedure is also performed to investigate unexplained or persistent abnormal uterine bleeding, such as bleeding between periods or after menopause. This diagnostic step helps determine if the bleeding source is from the endocervical lining, potentially caused by polyps or other cellular changes. Furthermore, an ECC may be necessary for patients with a positive test for high-risk Human Papillomavirus (HPV) who have inconclusive findings on a colposcopy.
What Happens During the Procedure
The ECC is usually performed in an outpatient setting, often immediately following a colposcopy. A speculum is inserted into the vagina to hold the walls apart and allow the healthcare provider to clearly view the cervix. The provider may apply a cleansing solution to the cervix and may use an instrument to stabilize the cervix before tissue collection.
The actual collection involves inserting a slender instrument, either a small, spoon-shaped curette or a brush, into the opening of the cervical canal. The instrument is gently rotated or moved to scrape a thin layer of tissue from the inner lining of the canal. This tissue sample is then immediately preserved in a solution and sent to a pathology lab for analysis. The procedure itself is very brief, often lasting less than five minutes, though the overall visit may be longer.
Most patients describe the sensation as a brief, intense cramping or pressure, similar to menstrual cramps, rather than sharp pain. In some cases, a local anesthetic may be administered to minimize discomfort, especially if other biopsies are also being taken.
Post-Procedure Care and Immediate Recovery
It is common to experience mild cramping, which can usually be managed with over-the-counter pain relievers. Light vaginal spotting or bleeding is also expected for a few days after the procedure, along with a dark or discolored discharge if a solution was applied to the cervix to control bleeding.
To promote healing and reduce the risk of infection, patients are generally advised to avoid inserting anything into the vagina for a specified period, often 48 hours or more. This includes abstaining from sexual intercourse, avoiding the use of tampons, and refraining from douching. Strenuous exercise or heavy lifting should also be avoided for at least 24 to 48 hours to prevent unnecessary straining of the area.
Patients should contact their healthcare provider immediately if they experience any signs that could indicate a complication, such as heavy vaginal bleeding that soaks more than one sanitary pad per hour. Other warning signs include severe, worsening pelvic pain that does not improve with medication, a fever, or a foul-smelling vaginal discharge.
Interpreting the Pathology Findings
Once the collected tissue reaches the laboratory, a pathologist examines the cells under a microscope to generate a diagnostic report. The timeframe for receiving these results is typically one to two weeks, depending on the lab and the complexity of the findings. The pathology report will classify the appearance of the endocervical lining cells.
A Normal/Benign result indicates that the tissue sample showed only healthy cells or benign changes, such as inflammation. If the report notes Hyperplasia, it means there is an abnormal increase in the number of normal-appearing cells, which can sometimes be a reaction to hormonal changes or irritation. Hyperplasia is an abnormal growth pattern but is not considered pre-cancerous.
A more significant finding is Dysplasia, which refers to pre-cancerous changes in the cervical tissue. This is typically categorized by the severity of the cellular abnormality, such as low-grade or high-grade changes. High-grade results indicate more advanced changes that are closer to becoming cancer and require closer attention and likely further treatment. The report may also indicate the presence of abnormal glandular cells, which can suggest pre-cancerous changes in the gland tissue of the endocervical canal.
The specific language used in the report will guide the next steps, which may range from continued routine monitoring to a recommendation for a definitive treatment procedure.