Evaluation of Endocervical Curettage in Colposcopy in the Turkish Cervical Cancer Screening Program.
Utku AkgorNejat OzgulAli Can GunesMurat TurkyılmazMurat GultekinPublished in: Journal of clinical medicine (2024)
Background/Objectives: To investigate the risk factors for CIN2+ lesions (cervical intraepithelial neoplasia 3 or worse) in endocervical curettage (ECC) and to evaluate the relationship between the addition of ECC to punch biopsy in terms of the yield of CIN2+ lesions. Methods: Between February 2018 and 2019, data on colposcopy results from 11,944 patients were gathered from the Cancer Department of the Turkish Ministry of Health across the country. A total of 6370 women whom were referred to colposcopy were included in this study. Risk factors were identified using both univariate and multivariate logistic analyses. Results: The median age was 42 years old (range, 30-65). ASC-H (atypical squamous cells-suggestive of high-grade squamous intraepithelial lesion)/HSIL (high-grade intraepithelial lesion) cytology (OR 7.648 95% CI (3.933-14.871)) and HPV (human papillomavirus)-16/18 infection (OR 2.541 95% CI (1.788-3.611)) were identified as risk factors for having CIN2+ lesions. CIN2+ diagnostic yield by ECC is only 1.2% all patients. CIN2+ diagnostic yield by punch biopsy and ECC are 9.7% and 6% of patients, respectively. A higher CIN2+ yield by ECC was observed with increasing age. Among cytology groups, ASC-H/HSIL has highest CIN2+ yield by ECC. Finally, in patients with incomplete visualization of the squamocolumnar junction (SCJ), ECC yields approximately twice as many CIN2+ lesions. Conclusions: ECC should be considered in cases of advanced patient age and in situations where the SCJ is not routinely visualized. In addition, evaluation of the endocervical canal is necessary in HPV-positive cases infected with HPV-16/18 types and in cases infected with HPV of any type but with cytological abnormalities.
Keyphrases
- high grade
- low grade
- end stage renal disease
- ejection fraction
- chronic kidney disease
- risk factors
- newly diagnosed
- cervical cancer screening
- peritoneal dialysis
- adipose tissue
- type diabetes
- healthcare
- squamous cell carcinoma
- electronic health record
- metabolic syndrome
- patient reported outcomes
- papillary thyroid
- machine learning
- polycystic ovary syndrome
- insulin resistance
- risk assessment
- artificial intelligence
- fine needle aspiration
- patient reported
- lymph node metastasis