To Explore The Rational Application Of Endocervical Curettage In Cervical Cancer Screening

ObjectiveTo evaluate the value of endocervical curettage(ECC)in the detection of cervical high-grade intraepithelial lesions and above(HSIL+)and to explore the applicable indications of ECC in cervical cancer screening.MethodsThe patients who were referred for colposcopy in our hospital from January 2017 to May 2021 were reviewed and the patients who underwent both colposcopically cervical directed biopsy(CDB)and ECC at the same time were screened.Collected complete medical records of patients with pathological findings of HSIL+,including basic conditions and clinical characteristics.The pathological results of ECC and CDB were both HSIL+ as the concordant group,and the results were different as the discordant group.The discordant group was divided into two subgroups: ECC pathological results were higher than point biopsy(ECC>CDB)and lower than point biopsy(ECC<CDB).The chi-square test was used for comparison between groups,and the Bonferroni correction post-hoc test was used.Variables with differences between groups were analyzed by multivariate logistic regression.The related factors affecting the inconsistency of pathological results between ECC and CDB and ECC>CDB were analyzed.Results(1)A total of 2568 patients were screened,and a total of 571 patients with HSIL+ had complete data.Among the 2568 patients,944 cases were HSIL+.Among the HSIL+ patients,only ECC,ECC and CDB,and only CDB detected HSIL+ in 98cases(10.4%),565 cases(59.9%),and 281 cases(29.7%).Among the 571 HSIL+patients,207(36.2%)in the discordant group and 364(63.8%)in the concordant group;53 patients in the discordant group had ECC>CDB,and 154 had ECC<CDB.(2)Compared with the concordant group,in the 60-69 years group(7.3% vs13.2%),the minority group(22.2% vs 15.1%),the premenopausal group(74.4% vs64.0%),the menopausal group(18.4%)% vs 26.1%),no other disease group(94.2%vs 89.0%),other disease group(5.8% vs 11.0%),cytology NILM(23.2% vs 15.1%)and HSIL+ group(21.2% vs 35.2%)),no clinical symptoms(85.5% vs 75.0%),abnormal vaginal bleeding group(11.6% vs 21.4%),cervical type II transformation zone(9.2% vs 3.0%),type III transformation zone(77.8% vs 85.2%),colposcopy initial diagnosis of LSIL(18.4% vs 7.4%)and cervical cancer(2.4% vs 11.0%)distributions were statistically different,P < 0.05.There were no significant differences in the distribution of BMI,work nature,place of residence,pregnancy,number of vaginal deliveries and HPV infection status.(3)Multivariate logistic regression analysis showed that cytology was NILM(OR=2.196,95%CI: 1.270-3.798,P=0.005),ASC-US(OR=1.846,95%CI:1.072-3.179,P= 0.027),ASC-H(OR=1.708,95%CI: 1.028～2.837,P=0.039),type II transformation zone(OR=2.969,95%CI: 1.29～6.831,P=0.010),primary diagnosis of colposcopy NILM(OR=5.957,95%CI: 1.593～22.281,P=0.008),LSIL(OR=8.027,95%CI: 2.653～24.285,P<0.001),HSIL(OR=3.575,95%CI: 1.336~9.567,P=0.011)was an independent factor for the inconsistency between ECC and point biopsy results.(4)Comparison of the two subgroups,in the age group of 50-59 years(32.1%vs 18.2%),the non-menopausal group(60.4% vs 79.2%),the menopausal group(39.6% vs 20.8%),the cervical type I transformation zone(3.8% vs 16.3%)and type III transformation zone(88.7% vs 74.0%)distributions were statistically different,P< 0.05.Multivariate logistic regression analysis showed that age,menopause and transformation zone types were not ECC>CDB independent influencing factors.ConclusionsECC is a necessary supplement to cervical biopsy,which can detect endocervical lesions missed by colposcopy cervical biopsy.It is recommended that patients aged50-59 years and type III transformation zone undergo ECC examination in cervical cancer screening.