Abstract
BackgroundIn the absence of practical and reliable predictors for whether the endocervical curettage (ECC) procedure should be performed, decisions regarding patient selection are usually based on the colposcopists’ clinical judgment instead of evidence. We aimed to develop and validate a practical prediction model that uses available information to reliably estimate the need to perform ECC in patients suspected of having cervical lesions.MethodsIn this retrospective study, 2088 patients who underwent colposcopy, colposcopically directed biopsy (CDB) and ECC procedures between September 2019 and September 2020 at the Second Hospital of Shanxi Medical University were included. The data were analyzed with univariate and multivariable logistic regression. Least absolute shrinkage and selection operator (LASSO) was used to select predictors for ECC positivity. The ECC prediction model was presented as a nomogram and evaluated in terms of discrimination and calibration. Furthermore, this model was validated internally with cross-validation and bootstrapping.ResultsSignificant trends were found for ECC positivity with increasing age (P = 0.001), menopause (P = 0.003), Human papillomavirus (HPV) status (P < 0.001), severity of ThinPrep Cytological Test (TCT) (P < 0.001), original squamous epithelium ectopia (P = 0.037) and colposcopy impression (P < 0.001) by multivariable logistic regression analysis. The ECC prediction model was developed based on the following predictors: age, menopause, symptom of contact bleeding, severity of TCT, HPV status, cervix visibility, original squamous epithelium ectopia, acetowhite changes and colposcopic impression. This model had satisfactory calibration and good discrimination, with an area under the receiver operator characteristic curve (AUC) of 0.869 (95% confidence interval 0.849 to 0.889).ConclusionsA readily applicable clinical prediction model was constructed to reliably estimate the probability of ECC positivity in patients suspicious of having cervical lesions, which may help clinicians make decisions regarding the ECC procedure and possibly prevent adverse effects.
Highlights
In the absence of practical and reliable predictors for whether the endocervical curettage (ECC) procedure should be performed, decisions regarding patient selection are usually based on the colposcopists’ clinical judgment instead of evidence
The international community follows a three-step screening method: cervical thin-layer liquid-based cytology or cytology combined with human papillomavirus (HPV) detection is performed as the primary screening [3]; cases that are suspicious or positive are referred to colposcopy; and histopathological specimens of the lesions, including colposcopically directed biopsy (CDB) and endocervical curettage (ECC) might be taken under colposcopy to diagnose cervical lesions [4]
Study design, setting and population In this retrospective study, we included all consecutive patients who underwent ECC procedures performed with colposcopy and CDB and were referred to the Second Hospital of Shanxi Medical University, China, based on abnormal co-test findings (HPV testing+cytology) or the presence of unexplained contact bleeding between September 2019 and September 2020
Summary
In the absence of practical and reliable predictors for whether the endocervical curettage (ECC) procedure should be performed, decisions regarding patient selection are usually based on the colposcopists’ clinical judgment instead of evidence. We aimed to develop and validate a practical prediction model that uses available information to reliably estimate the need to perform ECC in patients suspected of having cervical lesions. The international community follows a three-step screening method: cervical thin-layer liquid-based cytology or cytology combined with human papillomavirus (HPV) detection is performed as the primary screening [3]; cases that are suspicious or positive are referred to colposcopy; and histopathological specimens of the lesions, including colposcopically directed biopsy (CDB) and endocervical curettage (ECC) might be taken under colposcopy to diagnose cervical lesions [4]. Colposcopists usually perform ECC selectively based on personal experience instead of the evidence, possibly resulting in a higher incidence of adverse effects [12]. Further identification of subgroups of women most likely to benefit from ECC is urgently needed, but studies have lacked appropriate data or statistical power for such comparisons
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