What is the most appropriate next step when a colposcopic examination shows a positive endocervical canal curettage in a patient with a high-grade lesion?

When a colposcopic examination reveals a positive endocervical canal curettage (EC) in the context of a patient with a high-grade lesion, the most appropriate next step is to perform conization of the cervix. This procedure is essential because a positive EC indicates that there may be high-grade dysplasia or invasive carcinoma in the endocervical canal that is not adequately assessed through standard cervical cytology or colposcopy alone.

Conization allows for the removal of a cone-shaped section of the cervical tissue, which includes both the abnormal squamous cells from the ectocervix and the endocervical canal. This not only helps confirm the diagnosis through histologic evaluation but also serves as a therapeutic intervention for high-grade lesions. If invasion is confirmed or cannot be ruled out, further management and treatment plans can be developed based on the pathology findings.

In contrast, other choices such as repeating Pap smears or colposcopic examinations in a short time frame do not address the immediate need for definitive diagnosis and treatment posed by the findings of a positive curettage. No follow-up would neglect the potential severity of the findings and the necessary interventions required to address any existing lesions. Therefore, conization is the most