Role of endocervical curettage in detecting CIN2 + in postmenopausal women with persistent high-risk HPV and type 3 transformation zone.

Background: This study aimed to evaluate the effectiveness of endocervical curettage (ECC) in detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in HPV-positive postmenopausal women with a type 3 transformation zone (TZ3) and to identify additional predictive factors.

Methods: A retrospective observational study was conducted including 137 HPV-positive postmenopausal women who underwent colposcopy, ECC, and subsequent LEEP. Variables analyzed included age group, HPV genotype (16/18 vs. non-16/18), transformation zone type, cytology results, and ECC findings. Univariate and multivariable logistic regression analyses were performed to identify predictors of CIN2 + confirmed by LEEP histology.

Results: CIN2 + prevalence was 27.7% (38/137); ≥CIN3 occurred in 26/137 (19.0%). In multivariable analysis, high-grade cytology (adjusted OR [aOR] 4.65; 95% CI 1.92-11.30; p < 0.001), TZ3 (aOR 3.05; 1.05-8.85; p = 0.040) and hrHPV non-16/18 (aOR 2.52; 1.08-5.90; p = 0.032) were independently associated with CIN2+, while age ≥ 51 years was not (aOR 1.28; 0.57-2.85; p = 0.55). Absolute risks of CIN2 + were 36.8% with non-16/18 vs. 16.4% with HPV16/18. ECC (cut-off CIN2+) yielded sensitivity 73.7%, specificity 77.8%, PPV 56.0% and NPV 88.5%.

Conclusion: In postmenopausal women with persistent hrHPV, high-grade cytology and TZ3 are the main drivers of CIN2+ risk. ECC is most useful as a rule-out test (high NPV), whereas expedited diagnostic-therapeutic LEEP may be considered when ASC-H/HSIL coexists with TZ3 in women without fertility desire. The association between non-16/18 genotypes and CIN2+ observed here warrants confirmation in larger multicentre cohorts.