Predictive Value of Positive Endocervical Curettage Results Obtained During Colposcopy

Objective: The aim of this study was to evaluate the positive predictive value of endocervical curettage (ECC) during colposcopic examination in a dysplasia unit since the implementation of the new cervical cancer screening program in Germany (January 2020). Methods: A total of 202 patients who presented for colposcopy at the Dysplasia Unit of the University Hospital Aachen, Germany, between January 2020 and October 2023, who had cervical intraepithelial neoplasia 1+ (CIN1+) in the endocervical curettage and received a loop-excisional procedure of the cervix (LEEP), were included in a retrospective cohort analysis using machine learning techniques (random forest analysis and leave-one-out cross-validation). Results: There was a low agreement between the results of the ECC and the CIN status after LEEP (kappa 0.0239). A positive result in the histological specimen of the excisional procedure of the cervix (CIN2+) was obtained in 73.7% in case of CIN1 detection in the ECC, 69.4% in case of CIN2 detection in the ECC, and 80.6% in case of CIN3 in the ECC. In the multivariate analysis, the result of colposcopy and the transformation zone, especially combined (kappa 0.259, p = 0.0004), had the highest predictive value with regard to the CIN status. Conclusions: ECC is associated with a low agreement rate in comparison to the final histological result of the LEEP, which should be kept in mind when counseling patients. A finding of CCIN1in an ECC obtained during colposcopy following abnormal HPV-based cervical cancer screening results should be considered an indication of a possible intracervical dysplasia.