关键词: 宫颈高级别病变, 阴道镜, 宫颈管搔刮术, 人乳头状瘤病毒疫苗, <30岁女性

Abstract: Background　Since the approval of HPV vaccines in China in 2017，a portion of young women have been vaccinated. However，whether HPV vaccination affects the detection of HSIL in young women and the diagnostic value of ECC remains unclear. Objective　To understand the clinical characteristics of high-grade squamous intraepithelial lesion （HSIL） in women under 30 years old and to explore the value of endocervical curettage（ECC） under colposcopy in detecting HSIL. Methods　A retrospective analysis was performed on patients under 30 years of age who underwent colposcopy-guided cervical biopsy and/or ECC in the Colposcopy Room of the Gynecological Clinic，Beijing Obstetrics and Gynecology Hospital，Capital Medical University，from June 2021 to June 2022. A total of 427 cases were enrolled. All patients underwent cytology and high-risk HPV testing，and were referred for colposcopy due to abnormal screening results. With pathological results as the gold standard for diagnosis，the diagnosis of cervical intraepithelial lesions was made in accordance with the WHO 2014 two classification system，which includes high-grade squamous intraepithelial lesion（HSIL） and low-grade squamous intraepithelial lesion（LSIL）. The HSIL detection rate was defined as the number of cases with HSIL detected by cervical biopsy and/or ECC divided by the total number of cases. The biopsy detection rate was defined as the number of cases with HSIL detected by cervical biopsy divided by the total number of cases. The ECC detection rate was defined as the number of cases with HSIL detected by ECC divided by the total number of cases. The additional HSIL detection rate of ECC was defined as the number of cases with HSIL detected by ECC but not found in cervical biopsy divided by the total number of cases，so as to evaluate the diagnostic value of ECC.Multivariate Logistic regression analysis was used to explore the clinical characteristics of HSIL detection in women under 30 years old. Results　Among the 427 patients，155 cases（36.3%） underwent only multi-point cervical biopsy，with 19 cases diagnosed with HSIL；272 cases（63.7%） underwent both multi-point biopsy and ECC，with 76 cases diagnosed with HSIL，among which 2 cases were additionally detected by ECC. The overall HSIL detection rate was 22.2% （95/427），the biopsy detection rate was 21.8%（93/427），the ECC detection rate was 1.6%（7/427），and the additional HSIL detection rate by ECC was 0.5%（2/427）. Results of multivariate Logistic regression analysis showed that cytological HSIL（OR=7.274，95%CI=1.901-27.828） and positive HPV 16/18（OR=10.833，95%CI=1.317-89.135） were risk factors for HSIL detection（P<0.05）. Conclusion　In women under 30 years old，cytology HSIL and HPV 16/18 infection are two independent risk factors affecting HSIL detection. Younger age group（<25 years），colposcopic transformation zone，and HPV vaccination are not relevant influencing factors for the detection of HSIL. ECC little additional significance in detecting HSIL in people under 30 years old. It is suggested that ECC may not be necessary for women under 30 years old who do not have the two independent risk factors mentioned above，regardless of the transformation zone and vaccination status.

Key words: High-grade squamous intraepithelial lesion, Colposcopy, Endocervical curettage, Human papillomavirus vaccines, Women under 30 years old