The diagnostic value of colposcopy in postmenopausal women: a retrospective study

Postmenopausal women undergo physiological changes in the vaginal and cervical transformation zones, which influence the accuracy of cervical cancer screening and colposcopy results. This study aims to evaluate the immediate risk of cervical intraepithelial neoplasia (CIN) in postmenopausal women who are positive non-16/18 high-risk human papillomavirus (HPV) and Thinprep Cytologic Test (TCT) results classified as either no intraepithelial lesion or malignancy (NILM) or atypical squamous cells of undetermined significance (ASC-US), examine the clinical implications of cervical cancer screening and colposcopy in this population and identify potential approaches to enhance current diagnostic protocols.

This study collected and analyzed clinical data from postmenopausal women who tested positive for either abnormal cytology or HPV between January 2023 to December 2024 at a single center hospital. The incidence of CIN was compared between the HPV16/18-positive group and the non-HPV16/18-positive group among patients with TCT results categorized as NILM or ASC-US. Additionally, a detailed analysis of the colposcopic results was performed for non-HPV16/18-positive women presenting with NILM or ASC-US on TCT.

Among the 392 patients who were non-HPV16/18-positive and had TCT results indicating either NILM or ASC-US, there were 50 cases (12.76%) of CIN 1, 18 cases (4.59%) of CIN 2/3, and 1 case (0.26%) of cervical cancer. Of these patients, 312 had TCT results classified as NILM and 80 as ASC-US. Within these subgroups, 15 cases (4.81%) in the NILM group and 4 cases (5.00%) in the ASC-US group developed CIN 2 + lesions. The difference between the two groups was not statistically significant (p = 0.94). Among the 104 patients diagnosed with CIN 2 + lesions, 27 cases (25.96%) exhibited symptoms such as postmenopausal vaginal bleeding or abnormal discharge symptoms of varying degrees.

Vaginal bleeding and abnormal discharge in postmenopausal women warrant immediate evaluation. For postmenopausal patients who are HPV 16/18‑negative and have NILM or ASC‑US cytology, routine surveillance is appropriate. Adjunctive testing with E6/E7 mRNA assays or p16/Ki‑67 dual‑staining may be employed; any abnormal result should prompt diagnostic work‑up.