High-grade squamous intraepithelial lesion diagnosis rate in patients undergoing cervical biopsy with colposcopy

Aim: Cervical cancer is the fourth most common malignancy among women worldwide and is closely associated with Human Papillomavirus (HPV) infections. The Pap smear test enables the early detection of preinvasive lesions, thereby allowing treatment before disease progression. This study aimed to determine the rate of high-grade squamous intraepithelial lesion (HSIL) in patients who underwent colposcopic biopsy due to abnormal cervical smear, HPV positivity, or suspicious cervical appearance. Methods: In this retrospective study, 993 patients who underwent colposcopic cervical biopsy at the Department of Obstetrics and Gynecology, Adnan Menderes University, between January 2019 and August 2024 were included. The patients' age, cytology findings, HPV genotype distribution, and biopsy pathology results were recorded. Statistical evaluations were conducted to assess both high-risk HPV positivity and the detection rate of HSIL. Results: The mean age of the patients was 43.92±10.55 years. HPV genotyping revealed a 64.1% prevalence of high-risk HPV type 16 and 18. The most frequent cytology results were normal (24.3%), ASC-US (21.1%), and LGSIL (18.3%). Biopsy pathology most commonly indicated cervicitis (70.4%) and CIN1 (LSIL) (14.1%), while the overall HSIL (CIN2 and CIN3) rate was 9.5%. High-risk HPV positivity was associated with a statistically significant increase in endocervical curettage (ECC) utilization and a higher likelihood of HSIL detection. In patients with HSIL detected by cytology or ECC pathology, the rate of HSIL in biopsy findings was also significantly elevated. Conclusion: These findings suggest that HPV 16/18 positivity and the presence of HSIL in cytology predict HSIL detection in advanced diagnostic procedures. Early diagnosis and treatment of preinvasive lesions through colposcopy and adjunct diagnostic methods should be prioritized to reduce the incidence and mortality of cervical cancer. Keywords: HPV, Cervical biopsy, Cervical cancer, Squamous intraepithelial lesion