Comparative evaluation of hrHPV DNA testing, cervical cytology and histopathology for cervical precancer detection

Cervical cancer remains a major public health challenge in India, driven primarily by persistent high-risk HPV infection. Hence, this prospective study evaluated hrHPV DNA testing, cervical cytology and co-testing in 400 symptomatic women, using histopathology as the gold standard for CIN2+ detection. HPV DNA testing showed the highest sensitivity (90%) and diagnostic accuracy (63.8%) compared with cytology and co-testing, while ROC analysis confirmed its superior performance (AUC 0.75). HPV16 was the predominant genotype, followed by HPV18, HPV52 and HPV58, together accounting for most high-grade lesions. Thus, we show HPV DNA testing as a more reliable primary screening method than cytology in resource-limited settings.