Cytology, High-Risk HPV Genotyping, and Histology in Cervical Pathology: A Retrospective Cohort Study

Background/Objectives: Cervical cancer prevention relies on cytology, high-risk human papillomavirus (HR-HPV) testing, and histological confirmation, but these modalities may disagree. We quantified test concordance and determinants of CIN2+ in a specialized gynecologic referral cohort with very low HPV vaccination coverage. Methods: We retrospectively analyzed 172 women evaluated for suspected or established cervical pathology between 2022 and 2024. Of these, 160 had a definitive HPV result and 130 had histology; histology-based performance analyses used complete cases and are conditional on biopsy verification. Cytology was categorized by the Bethesda system, HR-HPV genotypes were recorded, and histology was dichotomized as CIN2+ versus ≤CIN1. Results: Among 160 women with definitive HPV results, 109 (68.1%) were HPV-positive. HPV-positive women were younger (median 33 vs. 43 years, p < 0.001) and, among biopsied women, more frequently had CIN2+ (70.2% vs. 22.2%, p < 0.001). Cyto-histological agreement was fair (65.0%, κ = 0.32). HPV16/18 was strongly associated with CIN2+ (OR 6.85, 95% CI 2.54-18.49). Within histologically verified complete cases, HPV DNA positivity had the highest apparent sensitivity (91.7%), whereas HPV16/18 had the highest PPV (86.0%). Conclusions: Cytology and HR-HPV testing provide complementary information in this referral-enriched cohort. Because disease prevalence was high and biopsy verification was selective, predictive values and apparent diagnostic-performance estimates should not be extrapolated directly to population screening; external validation in primary-screening populations is required.