Sticky Situations in Colposcopy Conference: to Telfa or Not

Summary: Introduction: Cytologists play a critical role in colposcopy conferences. In this setting, they not only provide cyto-histologic results for correlation with the colposcopic and clinical findings but they can identify areas for quality improvement. For example, we observed that when we use the wording ""insufficient/scant"" for endocervical curettings (ECCs), our clinicians often misinterpreted this as a negative diagnosis. Prior studies have shown that patients with suboptimal ECCs may have significant pathologic findings on repeat procedure. We sought to find factors associated with inadequate ECCs to see if we could make recommendations to decrease the frequency of this occurrence. Materials and Methods: We searched our anatomic pathology database for consecutive ECCs over a 2-month period. Diagnoses of suboptimal tissue were based on wording of ""insufficient/scant"" in the final diagnosis. Data collected included age, HPV type, concurrent cervical/endometrial biopsy, history of atypical squamous cells of undetermined significance (ASCUS)/dysplasia/carcinoma, proceduralist type, final diagnosis, and presence of a Telfa pad. Chi-square and multivariate logistic regression analyses were used to identify variables associated with increased frequency of insufficient specimens. Results: Of 400 ECCs, 190 were ""suboptimal"" (47.5%) and 210 ""diagnostic"" (52.5%). Median patient age was 38 years with age >38 years correlating with higher frequencies of insufficient specimens on univariate and multivariate analyses (n=107/198; 54.0%) versus <38 years (n=83/202; 41.1%), p=0.01. Telfa pad use was also associated with an increased percentage of suboptimal ECCs on univariate and multivariate analyses (n=30/43; 69.8%) compared to no Telfa pad (n=160/357; 44.8%), p=0.002. Diagnoses of dysplasia/carcinoma on concurrent biopsies tracked with lower rates of suboptimal samples (p<0.0001). Prior pap/biopsy history, HPV status, procedurist type, and concurrent cervical/endometrial biopsy did not significantly impact the rate of suboptimal specimens (Table 1). Conclusions: Age >38 years and Telfa pad use are significantly tied to elevated rates of insufficient diagnostic material for endocervical curettages. To optimize specimen cellularity, usage of Telfa pads for the submission endocervical curettage samples should be strongly discouraged.