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Chromogenic In Situ Hybridization as a Tool for HPV-Related Head and Neck Cancer Diagnosis
Published on: June 14, 2019
From HSIL to SCC: A Real-World Analysis of Diagnostic Upgrade Pathways and Pitfalls in Cervical Cytology
Yan Qin1, Hongyi Gao1, Yanxia Liao1
1Department of Pathology, Guangdong Women and Children Hospital, Guangzhou, China.
Context:
Cervical cancer remains a major global health concern. Liquid-based cytology (LBC) is a cornerstone of screening, but its diagnostic accuracy for high-grade lesions, particularly in specific populations such as Southern China, requires ongoing evaluation.
Objective:
To evaluate the diagnostic accuracy of LBC for high-grade squamous intraepithelial lesion (HSIL) and squamous cell carcinoma (SCC) in a large Chinese cohort, and to analyse associated human papillomavirus (HPV) genotype patterns and diagnostic pitfalls.
Design:
Retrospective analysis of 518,519 LBC records (2014-2024), focusing on 1758 cases diagnosed as HSIL, HSIL suspected SCC, or SCC.
Results:
The detection rate for HSIL/SCC was 0.34%. Histopathological follow-up was available for 1315 cases. The concordance rates between cytology and histology were 44.5% for HSIL and 78.5% for SCC. All 52 cases labelled "HSIL suspected SCC" were confirmed as invasive SCC (positive predictive value [PPV] = 100%). Among discordant cases, 21.9% of cytological HSIL were upgraded to SCC on histology, while 67 cases originally diagnosed as HSIL/SCC were reclassified as other malignancies (e.g., adenosquamous carcinoma). HPV genotypes 16, 58, 52, and 33 were predominant (70.0% in HSIL, 81.0% in SCC). A small proportion (2.3%) of high-grade lesions were HPV-negative.
Conclusion:
LBC demonstrates high specificity for SCC and useful predictive value for the "HSIL suspected SCC" category. However, diagnostic challenges remain, including under-recognition of invasive carcinoma in HSIL cases and misclassification of non-squamous malignancies. These findings underscore the importance of cytological expertise and the complementary role of HPV testing within screening programs.
