Grading of squamous dysplasia in endocervical curettage specimens: The case for conservative management of mild endocervical dysplasia.

Objective: To determine if the severity of dysplasia in a loop electrical excision procedure (LEEP) specimen is different for women with a preoperative endocervical curettage (ECC) positive for mild dysplasia.

Study Design: Records from a colposcopy clinic for a 5-year period were reviewed. The subjects were divided into 3 groups: group I, ECC positive for mild dysplasia; group II, mild ectocervical dysplasia; and group III, ECC positive for dysplasia not identified as mild. Outcome variables were a histologic diagnosis on the LEEP specimen and recurrence of dysplasia. Raw data were analyzed.

Results: A total of 753 patients underwent a LEEP procedure. One hundred seventy-three (23%) met the inclusion criteria: 37 in group I, 66 group II and 70 group III. Group III had an increased risk of severe dysplasia on LEEP, 68% vs. 25%, over groups I and II. Patients in group III who had minimally abnormal entry cervical cytology had an increased relative risk of 2.13 for severe dysplasia on LEEP as compared to group I.

Conclusion: Patients with mild dysplasia on ECC appear to have no greater risk of severe dysplasia on subsequent LEEP specimens than have counterparts with isolated ectocervical mild dysplasia. These patients can be offered conservative follow-up with colposcopy rather than initial definitive therapy.