Evaluation of the Outcomes of Patients Undergoing Colposcopy for High-Risk Human Papillomavirus Positivity and/or Abnormal Cervical Cytology

TL;DR

This study examines the outcomes of women undergoing colposcopy due to high-risk HPV or abnormal cervical cells, finding that HPV 16 and 18 are most linked to severe cervical lesions.

Contribution

The study highlights the importance of immediate colposcopy for high-risk HPV-positive patients with normal cytology to detect cervical lesions early.

Findings

HPV type 16 was the most common in patients with CIN2+ lesions (47.5%).

ECC detected CIN2+ lesions in 5.6% of patients, with 74 cases showing lesions in both ECC and biopsy.

29.3% of patients with high-risk HPV and normal cytology had CIN2+ lesions.

Abstract

Objectives: The main objective of the present study was to evaluate the outcomes of patients referred for colposcopy due to human papillomavirus (HPV) positivity and/or abnormal cytology. Methods: A retrospective analysis was conducted on women who underwent colposcopy between January 2015 and December 2023. Demographic data and results of the colposcopy result were obtained from the patient files and the electronic gynecologic oncology clinic database. Results: A total of 2682 patients were included in the analysis. A cervical biopsy identified a cervical intraepithelial neoplasia (CIN)2+ (CIN2, CIN3, and invasive cancer) lesions in 361 patients (13.5%), while endocervical curettage (ECC) identified a CIN2+ lesions in 148 patients (5.6%). A total of 74 patients exhibited CIN2+ lesions in both cervical biopsy and ECC samples, while 74 patients displayed CIN2+ lesions exclusively in ECC samples. The distribution of high-risk HPV positivity in 435 patients with CIN2+ lesions revealed that 47.5% of patients were positive for HPV type 16, while 8.9% were positive for HPV type 18. A total of 50% of all patients diagnosed with CIN2+ lesions by ECC alone were found to be positive for HPV type 16 (37/74). Of the 116 patients with high-risk HPV positivity and normal cytology, 34 (29.3%) were high-risk HPV other-positive. Conclusion: HPV type 16 and 18 positivity represents the highest-risk groups in terms of CIN2+ lesion development. ECC should be considered, in particular, in women with HPV 16 positivity. Colposcopy should be performed immediately, rather than after one year, in women with high-risk HPV other-positivity and normal cervical cytology, in order to increase the detection rate of CIN2+ lesions.