When is endocervical curettage (ECC) recommended as part of the evaluation of postmenopausal vaginal bleeding?
—Mary McCrossan, MD, Wilmington, Del.

ECC is warranted in a woman with postmenopausal uterine bleeding if the clinician suspects cervical cancer or if endometrial biopsy or curettage has revealed the presence of endometrial cancer, in order to determine whether there is cervical involvement of the lesion. ECC should also be performed if the patient has had a recent abnormal cervical cytology (Pap) test or has not had a Pap test in several years. In the presence of normal cervical cytology, the likelihood of an endocervical neoplastic lesion is extremely low, and ECC is not cost-effective.
—Daniel R. Mishell Jr, MD (111-2)

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