Abstract
OBJECTIVE: To investigate the distribution of colposcopy directed ectocervical biopsy and endocervical curettage (ECC) results, and to identify patients who may benefit from ECC. METHODS: This retrospective study analyzed the clinical data of 47,134 patients who underwent colposcopy directed ectocervical biopsy and ECC between January 2021 and December 2023. Risk factors were identified by univariate and multivariate logistic analyses. RESULTS: The positive rate of the final histopathological diagnosis was 37.1% (17,503/47,134), with 22.8% (10,724/47,134) for low-grade squamous intraepithelial lesion (LSIL) and 14.4% (6,779/47,134) for high-grade squamous intraepithelial lesion (HSIL) or worse lesions (≥HSIL). At final diagnosis of LSIL, HSIL, adenocarcinoma in situ (AIS), HSIL+AIS, squamous cell carcinoma (SCC), adenocarcinoma (ADC), and adenosquamous carcinoma (ASC), the additional diagnostic yield of ECC were 3.1%, 4.5%, 11.2%, 6.7%, 15.6%, 3.3%, and 0.0%, respectively. Multivariate analysis identified that age over 45 years old, high-risk human papillomavirus (HPV) infection, atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H) + (including ASC-H, HSIL and SCC) or atypical glandular cells (AGC) cytology and transformation zone (TZ)3 were risk factors for additional lesions detection. CONCLUSIONS: ECC is a useful procedure for detecting additional endocervical lesions, and is recommended for patients aged ≥ 45, with high-risk HPV infection, ASC-H + or AGC cytology, and TZ3, as it will help reduce the rate of missed diagnosis of cervical lesions.