Yield of endocervical curettage in detecting cervical intraepithelial neoplasia grade 2 or higher during colposcopy: A prospective, cross-sectional study

Abstract

Objective: This study assessed the prevalence and factors associated with detecting cervical intraepithelial neoplasia grade 2 or higher (CIN2+) via endocervical curettage (ECC) during colposcopy. Methods: Between December 2020 and September 2023, a prospective, cross-sectional study involving women with abnormal cervical cancer screening results who underwent colposcopy was conducted. ECC was performed via a Kevorkian endocervical curette following colposcopy-directed biopsy. The exclusion criteria were glandular cytology abnormalities, pregnancy, post-hysterectomy status, and cervical cancer. Results: The study included 569 women, with a mean age of 41.6 ± 11.7 years. Among the participants, 78.9% presented with low-grade cytology, whereas 21.1% presented with high-grade cytology. All of the patients underwent ECC, with 0.4% (two patients) yielding inadequate samples. ECC detected CIN2+ lesions in 11.6% of the patients (95% confidence interval [CI], 9–14.3). Univariable analysis revealed that age, menopausal status, history of CIN2+, high-grade cytology, and high-grade colposcopy impression were significant factors for CIN2+ detection by ECC. Multivariable analysis confirmed high-grade cytology as the sole independent factor (adjusted odds ratio [OR], 13.81 [95% CI, 4.60–41.42], P < 0.001). ECC added a diagnostic yield of 2.9% (95% CI, 1.5–4.3) for detecting CIN2+ lesions missed by colposcopy-directed biopsy. Multivariable analysis demonstrated an independent association between human papillomavirus 16 (HPV-16) infection and the additional diagnostic benefit of ECC, with an adjusted odds ratio (OR) of 6.26 (95% CI, 1.49–26.23, P = 0.012). Conclusion: This study highlights the critical role of ECC in detecting CIN2+ lesions, particularly in patients with high-grade cytology or HPV-16 positivity.