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Abstract

Background: Cervical cancer remains a significant health burden, particularly in low-resource settings. Accurate detection of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) is critical for prevention. Colposcopy-directed biopsy (CDB) may miss lesions when the squamocolumnar junction (SCJ) is not visible, especially in women with Type 3 transformation zone (TZ). Endocervical curettage (ECC) has been proposed as a complementary diagnostic tool, though its utility remains underexplored. This study evaluates the diagnostic accuracy of ECC in detecting CIN2+ lesions, particularly in women with non-visible squamous cell junctional lesions (SCJ).
Methods: This cross-sectional study was conducted at the Colposcopy Clinic of the Gynaecological Oncology Department, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from November 2021 to October 2022. A total of 117 women aged 30–60 years with abnormal cervical screening results underwent colposcopy, CDB, and ECC. SCJ visibility was recorded. Histopathological findings from CDB and ECC were analyzed to assess ECC's diagnostic performance. Statistical analysis included chi-square tests and logistic regression.
Results: CIN2+ was detected in 35.9% of women using either colposcopy-directed biopsy (CDB) or endocervical curettage (ECC), with both methods identifying exclusive cases. Non-visible squamocolumnar junction (SCJ) significantly increased ECC-detected CIN2+ (p=0.021). Multivariate analysis confirmed SCJ non-visibility as an independent predictor (AOR=2.67, p=0.041), while age ≥50 lost significance. CDB and ECC are complementary in CIN2+ detection.
Conclusion: ECC enhances CIN2+ detection in women with non-visible SCJ and should be considered in cases of unsatisfactory colposcopy to improve diagnostic yield.