Curettage is a procedure in which a doctor removes tissue by scraping it from a surface or from inside a body cavity. The doctor uses a small instrument called a curette with a spoon-shaped or loop-shaped tip. The doctor then sends the scraped tissue to a pathologist for microscopic examination.
Curettage describes how a tissue sample was collected. It is not a diagnosis. Your pathology report may call the sample “curettage,” “curettings,” or “scrapings,” and it will list the diagnosis separately. This article explains where curettage is used and how it affects what your pathology report can tell you.
Where is curettage used?
Curettage is used in several parts of the body, either to collect a sample for diagnosis or to remove abnormal tissue as treatment. The most common types are:
- Uterus. A dilation and curettage (D&C) removes tissue from the lining of the uterus, called the endometrium. It is often done to find the cause of abnormal bleeding or to remove tissue remaining after a miscarriage. Tissue from a pregnancy is described in the report as products of conception. Your report may call this sample “endometrial curettings.”
- Cervix. An endocervical curettage (ECC) scrapes a small amount of tissue from the canal of the cervix. It is often performed during a colposcopy to look for abnormal cells that cannot be seen externally.
- Skin. Curettage removes some skin growths, such as seborrheic keratosis and some small basal cell carcinomas. For skin cancer, it is often combined with electrodesiccation, which uses heat to treat the base of the wound.
- Bone. Curettage is used to scrape out some noncancerous tumors and cysts from inside a bone. Examples include giant cell tumor of bone, enchondroma, and aneurysmal bone cyst. The space is then often filled with bone graft or bone cement.
What does a curettage sample look like in the laboratory?
A curettage sample usually arrives in the pathology laboratory as many small, loose tissue fragments. Because the tissue is scraped rather than cut out in one piece, it is often mixed with blood and, in the uterus or cervix, with mucus.
The gross description in your report reflects how the pathologist first saw the curettage sample. It often gives the total size of all the fragments together, rather than the size of a single piece. Small curettage samples are usually submitted in toto, meaning all of the tissue is processed and examined under the microscope.
How does curettage affect what the pathology report can tell you?
Curettage is a good way to sample a wide area, such as the entire lining of the uterus. Because the tissue comes out in fragments, however, some features cannot be measured on a curettage sample. Your report may note these limitations:
- Margins. A margin is the edge of tissue cut by the surgeon. The fragments in a curettage sample have no reliable edges, so the pathologist usually cannot say whether an abnormal area was completely removed.
- Size and depth. The pathologist cannot measure the full size of a tumor from fragments. The pathologist also cannot see how deeply a tumor has grown into the surrounding tissue, such as the muscle wall of the uterus.
- Heat damage. When curettage is combined with heat, the tissue edges can be distorted. This change is called cautery artifact, and it can make some cells harder to interpret.
- Amount of tissue. Some curettage samples contain very little tissue, or mostly blood and mucus. The report may describe the sample as “scant,” “limited,” or insufficient for diagnosis.
- Sampling. Curettage may miss a small abnormal area. A normal result on a curettage sample does not always rule out a problem, especially if symptoms continue.
These limitations are expected with curettage. When a feature cannot be assessed, it usually means the information will come from another sample, such as a larger surgical specimen, if one is needed.
How is curettage different from other ways of removing tissue?
Curettage is one of several ways a doctor can collect tissue for a pathologist. Each one produces a different kind of sample:
- Biopsy. A biopsy removes a small piece of tissue, usually as one or a few intact pieces. Curettage is sometimes described as a type of biopsy.
- Excision. An excision cuts out an entire lesion in one piece, usually with a rim of normal tissue. Unlike curettage, this allows the pathologist to examine the margins.
- Resection. A resection removes part or all of an organ. It provides the most complete information, including tumor size, depth, and margins.
What happens after a curettage?
The next steps after a curettage depend on the diagnosis in the pathology report, not on the procedure itself. Possibilities include:
- A noncancerous result. No further procedure may be needed. Your doctor may watch for any return of symptoms.
- A precancerous change or cancer. A larger procedure may be considered to remove the remaining abnormal tissue and assess features a curettage cannot measure, such as margins and depth.
- A skin growth treated by curettage. For some small skin cancers, the curettage itself is the treatment. Your doctor will check the area as it heals.
- An insufficient sample. A repeat curettage or a different type of sample may be considered if the first one did not contain enough tissue.
Your doctor will combine the curettage results with your symptoms and any imaging to decide what, if anything, is needed next.
Questions to ask your doctor
- Why was curettage chosen instead of another type of biopsy?
- Did the sample contain enough tissue to make a diagnosis?
- Was the abnormal area completely removed, or can that not be determined?
- Are there findings that could not be assessed on this sample?
- Do I need a larger procedure to learn more about the diagnosis?
- If my symptoms continue, will I need another sample?
- Was the curettage the treatment, or only a test?
- When should I expect to have a follow-up appointment?
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