Accuracy of cervical cytology and colposcopy-directed biopsy histology in diagnosing squamous intraepithelial lesions

Introduction
Discrepancies between cervical cytology, colposcopy-directed biopsy (CDB) histology, and the results of the excisional procedures have been a topic of ongoing debate in the literature. Aim of the research: This study aims to assess the scale of these discrepancies and to explore the potential clinical factors contributing to such differences.

Material and methods
In this retrospective study, the consistency between Pap smear or liquid-based cytology (LBC), CDB, and large loop excision of transformation zone (LLETZ) results was evaluated. A total of 157 patients who underwent the LLETZ procedure between January 2022 and July 2024 were included in the analysis. Data collected encompassed patient age at LLETZ, menopausal status, hormonal treatment, pregnancies, cytology, HPV test results, histopathology, HPV vaccination, and substance use.

Results
We found statistically significant associations between cytology and biopsy results (p < 0.05), cervical cytology and LLETZ histopathology results (p < 0.05), and between cervical biopsy results and histopathological findings from the LLETZ procedure (p < 0.05). High-grade lesions showed better concordance between cervical cytology, CDB, and excisional procedure, than low-grade lesions. CDB demonstrated higher sensitivity in detecting squamous intraepithelial lesions (SIL) in comparison with cervical cytology (97.06% and 94.85%, respectively). Still, cervical cytology as well as CDB failed to detect cancer (each in one case/one case each).

Conclusions
Transitioning to more reliable HPV-based screening is necessary to achieve global cervical cancer elimination goals. Understanding the impact of uncertainty on diagnostic decisions and clarifying the role of “experience” in colposcopic practice are also crucial.