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Cytomorphologic Findings Associated With High-Risk HPV Categories in PAP Smears.
Berfin Ekin Yildiz1, Nermin Koç1
1Department of Pathology, Haydarpasa Numune Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey.
Diagnostic Cytopathology
|May 30, 2026
Summary
Classical koilocytosis may help predict certain high-risk human papillomavirus (hrHPV) types in cervical cancer screening. However, cytomorphology alone is insufficient for precise hrHPV typing, offering only supportive value.
Area of Science:
- Oncology
- Virology
- Cytopathology
Background:
- High-risk human papillomavirus (hrHPV) is a primary cause of cervical cancer.
- Integrating molecular HPV testing into screening necessitates understanding its correlation with cytomorphologic features.
- This study investigates the predictive value of cytological features for specific hrHPV types.
Purpose of the Study:
- To assess the predictive value of cytological features in patients with positive Pap smears and single hrHPV category detection.
- To correlate specific cytomorphologic findings with HPV16, HPV18/45, or other pooled hrHPV types.
Main Methods:
- Retrospective analysis of 490 cases with abnormal Pap smears and single hrHPV category.
- hrHPV detection using a real-time PCR assay (Aptima HPV).
- Systematic review of liquid-based cytology slides for cytomorphologic features and statistical analysis with FDR correction.
Main Results:
- Classical koilocytosis showed a significant association with other pooled hrHPV types (adjusted p=0.011).
- Initial associations between HPV16 and nuclear hyperchromasia/membrane irregularity were not significant after FDR adjustment.
- No other cytomorphologic features correlated significantly with hrHPV categories.
Conclusions:
- Cytomorphology alone is not sufficient for precise hrHPV typing.
- Cytomorphologic features may provide supportive information in cervical cancer screening, especially where HPV testing is limited.
