Cervical Cancer Screening: Histologic Outcomes of HPV-Negative HSIL/ASC-H Cytology in a Tertiary Referral…

Cohort studyMedicina (Kaunas, Lithuania)· Feb 2026

Cervical Cancer Screening: Histologic Outcomes of HPV-Negative HSIL/ASC-H Cytology in a Tertiary Referral Cohort in Northern Thailand.

Sopita Prasertpakdi, Prapaporn Suprasert, Tanadon Salakphet, Surapan Khunamornpong

CytopathologyCohort studyClinical practiceQ4IF 0.1

HPV-negative HSIL/ASC-H cytology carries substantial risk of underlying CIN3 on biopsy.

Cervical Cancer Screening: Histologic Outcomes of HPV-Negative HSIL/ASC-H Cytology in a Tertiary Referral Cohort in Northern Thailand.

Sopita Prasertpakdi … Surapan Khunamornpong

Medicina (Kaunas, Lithuania) · Feb 2026 · Q4 in General Medicine

Background

Cotesting combines cervical cytology and HPV testing and usually identifies HSIL/ASC-H in association with HPV positivity; however, a small subset shows discordant results with high-grade cytology but negative HPV testing.

Methods

We retrospectively reviewed women referred to a tertiary colposcopy unit (January 2019-October 2025) with HPV-negative HSIL or ASC-H on cotesting.

n = 92 women

Results

half of these cases hid CIN3 despite the negative HPV test

HSIL CIN3

50%

ASC-H CIN3

33.3%

More results

Among 92 women with HSIL/ASC-H cytology who underwent cotesting, 84 were HPV-positive (35 HSIL, 49 ASC-H).

Eight cases (8.7%) remained HPV-negative after cytology review: 2/37 (5.4%) HSIL and 6/55 (10.9%) ASC-H.

Two of six HPV-negative ASC-H cases (33.3%) were CIN3.

More results

One patient had persistent high-grade disease requiring two excisional procedures during follow-up.

“

Conclusion · 1 of 3

HPV-negative HSIL/ASC-H cytology is uncommon but associated with a substantial risk of CIN3.

Conclusion · 2 of 3

The consistent p16 positivity in tissue-confirmed HSIL supports HPV-attributable disease and suggests that most discordant cases reflect false-negative HPV testing rather than HPV-independent pathology.

Conclusion · 3 of 3

High-grade cytology should prompt colposcopic evaluation regardless of HPV status, and management should not be de-escalated solely on the basis of a negative HPV test.

Cervical Cancer Screening: Histologic Outcomes of HPV-Negative HSIL/ASC-H Cytology in a Tertiary Referral Cohort in Northern Thailand.

Cervical Cancer Screening: Histologic Outcomes of HPV-Negative HSIL/ASC-H Cytology in a Tertiary Referral Cohort in Northern Thailand.

Related papers