Histopathological Outcomes in High-Risk HPV-Positive Women

AIM: High-risk human papillomavirus (hrHPV) testing is more sensitive than cervical cytology for detecting cervical precancer, but its lower specificity complicates management when cytology is negative. We evaluated biopsy findings and factors associated with cervical intraepithelial neoplasia (CIN) grade 2 (CIN2) or worse (CIN2+) in women with hrHPV positive and cytology negative.
MATRERIAL and METHOD: This single-center retrospective study included 644 women who underwent colposcopy and biopsy within six months of hrHPV-positive and negative-cytology results between May 2020 and March 2024. HPV was classified as HPV16, HPV18 without HPV16, or other hrHPV. Histology was categorized as non-malignant, CIN1, CIN2, or CIN3. Multivariable logistic regression evaluated factors associated with CIN1 and CIN2+.
RESULTS: Histology was non-malignant in 321 women (49.8%), CIN1 in 255 (39.6%), CIN2 in 46 (7.1%), and CIN3 in 22 (3.4%); 68 women (10.6%) had CIN2+. HPV16, HPV18, and other hrHPV were detected in 25.0%, 6.5%, and 68.5%, respectively. HPV distribution differed across histological categories (p=0.012). HPV16 was detected in 39.7% of women with CIN2+, versus 24.0% with non-malignant histology and 22.4% with CIN1. After adjustment for age and smoking, HPV16 was associated with CIN2+ versus non-malignant histology (odds ratio [OR]=2.04; 95% confidence interval [CI]=1.14–3.63; p=0.016) and CIN1 (OR=2.08; 95% CI=1.16–3.74; p=0.014). Age, HPV18, and smoking were not independently associated with CIN2+.
CONCLUSION: CIN2+ was found in one in ten women with hrHPV-positive and negative-cytology results. HPV16 conferred approximately twofold higher odds of CIN2+; however, more than half of CIN2+ cases occurred with other hrHPV types. HPV genotyping should complement risk-based surveillance and colposcopic decision-making.