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This study optimized ECC application for primary human papillomavirus (HPV) screening in patients with high-risk (HR)-HPV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study included patients with HR-HPV, who underwent subsequent cervical biopsy and ECC from January 1, 2014, to December 31, 2020. Logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs). The prediction model was presented as a nomogram and evaluated for discrimination and calibration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The additional detection rate of cervical intraepithelial neoplasia 2\u2009+\u2009lesions with ECC was 2.0% (77\/3887) in patients with HR-HPV. In multivariate risk factor analysis, HPV 16 infection presented a high risk of positive ECC, followed by HPV 33, HPV 58, and HPV 31. Irrespective of the abnormal cytopathological results, positive ECC was significantly increased (all\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). Females with acetowhite changes on colposcopy, transformation zone (TZ) type II, TZ type III, colposcopic impression of high-grade squamous intraepithelial lesion, or cancer were at a high risk of positive ECC. The final prediction model included significant variables from risk factor analysis, and had excellent calibration and classification capabilities, with an area under the receiver operating curve of 0.902 (95% CI, 0.881-0.922). Additionally, calibration analysis suggested consistency.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>As the additional detection value of ECC is limited. A satisfactory prediction model was designed to optimize ECC application in patients with HR-HPV infection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15330338241312573","type":"journal-article","created":{"date-parts":[[2025,3,20]],"date-time":"2025-03-20T16:49:20Z","timestamp":1742489360000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Risk Factors of Positive Endocervical Curettage and Predictive Model Construction Based on Primary Human Papillomavirus Screening"],"prefix":"10.1177","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4549-2806","authenticated-orcid":false,"given":"Hangjing","family":"Gao","sequence":"first","affiliation":[{"name":"Department of Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics &amp; Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guanxiang","family":"Huang","sequence":"additional","affiliation":[{"name":"Laboratory of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics &amp; 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