DIAGNOSTIC PERFORMANCE OF ASC-H CYTOLOGY FOR DETECTING CERVICAL HIGH-GRADE INTRAEPITHELIAL LESIONS AND CANCER

Area of Science:

• Gynecologic Oncology
• Cervical Cancer Screening
• Cytopathology

Background:

• Atypical Squamous Cells-High (ASC-H) cytology indicates a potential for high-grade cervical lesions.
• Understanding the risk of cervical high-grade intraepithelial lesions and cancer (HGIL+) is crucial for appropriate colposcopy referral.
• HPV testing is increasingly used in cervical cancer screening, influencing referral pathways.

Purpose of the Study:

• To estimate the probability of histologically confirmed cervical high-grade intraepithelial lesions and cancer (HGIL+) in women referred for colposcopy after ASC-H cytology.
• To compare this probability when ASC-H is a primary screening result versus triage after positive HPV testing.

Main Methods:

• Retrospective two-center study of women with ASC-H cytology referred for colposcopy (2018-2024).
• ASC-H cases classified as primary screening or HPV-positive triage.
• Histological confirmation of HGIL+ (high-grade cervical/vaginal intraepithelial lesion or cancer) was the primary outcome.

Main Results:

• 421 colposcopies were included; 56.1% were HPV-triage and 43.9% were primary screening.
• Overall HGIL+ rate was 50.6% (213/421).
• HGIL+ rates did not significantly differ between primary cytology (55.1%) and HPV-triage (47.0%) (p=0.099), but varied by age, being lowest in women over 50 (40.5%).

Conclusions:

• The probability of HGIL+ following ASC-H cytology referral is approximately 50%.
• HPV-positive triage context did not significantly alter the HGIL+ probability compared to primary ASC-H cytology.
• Age is a significant factor, with women over 50 showing a lower probability of HGIL+.