This research hypothesized that assessing paired boxed gene 1 methylation levels (PAX1<sup>m</sup>) and clinical characteristics could enhance the predictive accuracy of detecting additional high-grade squamous intraepithelial lesions or worse (HSIL +) through ECC that were not identified by colposcopy-directed biopsy (CDB).<h4>Methods</h4>Data from 134 women with HPV16/18 positivity undergoing CDB and ECC between April 2018 and April 2022 were collected and analyzed. Here, PAX1 is linked to squamous cell intraepithelial neoplasia.