Diagnostic Utility of Endocervical Curettage During Colposcopy Among Patients of Varying Risk Factors.

OBJECTIVE: Endocervical curettage (ECC) during colposcopy is recommended in certain circumstances; however, diagnostic use remains unclear. We evaluate the utility of ECC among patients with non-fully visualized squamocolumnar junction (SCJ) and certain patient socioeconomic factors. METHODS: Retrospective chart analysis was completed for patients aged older than 21 years who underwent a colposcopy at 2 study sites between 2012 and 2021. Demographics and histopathologic results were analyzed. RESULTS: A total of 1,516 colposcopies were reviewed; 73.8% (n = 1,119) had an ECC with colposcopy. Of those, 92.1% (n = 1,031) had benign ECC whereas 13.9% (n = 156) had a positive ECC at time of colposcopy. Most patients with benign ECC had benign/low-grade squamous intraepithelial lesion pathology on colposcopy biopsy (82.3%; n = 914; p < .001), and most patients with high-grade squamous intraepithelial lesion (HSIL) on ECC had HSIL on colposcopy biopsy (63.4%; n = 52; p < .001) However, when looking at patients with high-grade pathology on colposcopy biopsy, it was seen that most had benign or low-grade squamous intraepithelial lesion on ECC (79.5%; n = 205; p < .001). Most patients with adequately visualized SCJ on colposcopy were noted to have HSIL on biopsy and negative ECC (73%; n = 81; p < .001). This result was similar in patients with non-fully visualized SCJ, although not statistically significant. When stratified by socioeconomic status, most patients with high-grade lesions had a benign ECC. CONCLUSIONS: Endocervical curettage has been described to increase the identification of high-grade lesions at time of colposcopy. This descriptive study shows that many high-grade lesions at time of excisional procedure had a benign ECC on colposcopy, with no demonstrated clear additional utility in high-risk groups.

The Evolution of Anterior Total Hip Arthroplasty The Past, Present, and Future.

The anterior approach has become a widely used and accepted approach for total hip arthroplasty (THA). This approach offers a number of advantages including supine positioning, improved soft tissue management, and avoidance of taking down posterior structures. The approach has evolved significantly from its introduction in the late 19th Century due to advancements in technology. Specifically, developments in the table used for the approach, safer instrumentation, and fluoroscopic guidance with overlay technologies have helped the anterior approach gain popularity. This article reviews the evolution of the usage of the anterior approach, including the use of current and emerging technologies as well as the learning curve associated with switching to the anterior THA and the future of outpatient anterior THA.