Chen Yusha, Li Suyu, Chen Jiancui, Xue Huifeng, Zheng Xiangqin, Pan Diling
Cervical Disease Diagnosis and Treatment Health Center, Fujian Maternity and Child Health Hospital College of Clinical Medical for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
Department of Radiation Oncology, Fujian Maternity and Child Health Hospital, College of Clinical Medical for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
J Low Genit Tract Dis. 2025 Apr 1;29(2):111-117. doi: 10.1097/LGT.0000000000000863. Epub 2024 Dec 17.
This study evaluates the effectiveness of endocervical curettage (ECC) in detecting additional high-grade squamous intraepithelial lesions or worse (HSIL+) in women infected with human papillomavirus (HPV) types 16 and 18, which may be missed by biopsy alone.
A retrospective cohort study analyzed the medical records of 4,811 women referred for colposcopy due to HPV16/18 infection from January 2019 to December 2023. Patients underwent both biopsy and ECC. Statistical comparisons of various clinical factors between HSIL+ and low-grade or normal lesions were performed using χ 2 tests and logistic regression analyses, with stratified analysis to determine ECC's additional detection rate under different clinical conditions.
Endocervical curettage detected an additional 6.46% of HSIL+ lesions missed by biopsy alone, with the highest rates in women with normal colposcopic impressions (23.1%), those aged 50 or older (12%), type 3 transformation zones (9.5%), and postmenopausal women (11.9%). In contrast, younger women under 30 and those with type 1 or 2 transformation zones had significantly lower detection rates (2.9%). Logistic regression indicated that older age, type 3 transformation zone, higher grade cytological results, and abnormal colposcopic impressions are significant risk factors for HSIL+ detection via ECC ( p < .001).
Data from this study indicate that ECC would be beneficial for women over 30 with HPV16/18 infections, particularly those with type 3 transformation zones or normal colposcopy, as it enhances HSIL+ detection. However, it offers minimal benefit for younger women or those with type 1 or 2 transformation zones.
本研究评估宫颈管搔刮术（ECC）在检测感染16型和18型人乳头瘤病毒（HPV）的女性中额外的高级别鳞状上皮内病变或更严重病变（HSIL+）方面的有效性，这些病变可能仅通过活检会被漏诊。
一项回顾性队列研究分析了2019年1月至2023年12月因HPV16/18感染而接受阴道镜检查的4811名女性的病历。患者均接受了活检和ECC。使用χ²检验和逻辑回归分析对HSIL+与低级别或正常病变之间的各种临床因素进行统计学比较，并进行分层分析以确定ECC在不同临床情况下的额外检出率。
宫颈管搔刮术检测出了单独活检漏诊的6.46%的HSIL+病变，其中阴道镜印象正常的女性检出率最高（23.1%），50岁及以上女性为12%，3型转化区女性为9.5%，绝经后女性为11.9%。相比之下，30岁以下的年轻女性以及1型或2型转化区的女性检出率显著较低（2.9%）。逻辑回归表明，年龄较大、3型转化区、细胞学结果级别较高以及阴道镜印象异常是通过ECC检测HSIL+的显著危险因素（p <.001）。
本研究数据表明，ECC对感染HPV16/18的30岁以上女性有益，特别是那些有3型转化区或阴道镜检查正常的女性，因为它能提高HSIL+的检出率。然而，对年轻女性或有1型或2型转化区的女性益处极小。
