Risk-Based Triage Using Cytology and HPV Genotyping to Reduce Unnecessary Colposcopy: A Real-World Cross-Sectional Study.
HSIL cytology strongly predicts high-grade cervical lesions in colposcopy-referred women
Risk-Based Triage Using Cytology and HPV Genotyping to Reduce Unnecessary Colposcopy: A Real-World Cross-Sectional Study.
Despite the widespread adoption of hrHPV-based cervical cancer screening, the optimal triage strategy for women with low-grade cytological abnormalities and non-16/18 high-risk hrHPV (hrHPV) types remains debated.
This study evaluated the impact of ASCCP risk-based triage strategies on colposcopy referral and biopsy outcomes in a large tertiary care center.
This retrospective cross-sectional study included 2748 sexually active women aged 30-65 years who underwent colposcopy at Ankara Etlik City Hospital (January 2023-June 2025).
HSIL cytology raises CIN3+ risk over 20-fold versus lower-grade cytology
The mean age was 42.8 ± 8.1 years.
The overall CIN3+ prevalence was 15.9% (308/1932).
HPV16/18 combined with HSIL or ASC-H cytology conferred the highest risk (adjusted OR 17.88-21.67).
A risk-based triage approach suggested a potential reduction of approximately 29.7% in colposcopy utilization.
HSIL cytology and HPV16/18 positivity represent the highest-risk profile for CIN3+ and should remain primary indications for colposcopy.
Conversely, women with ASC-US or LSIL cytology and non-16/18 hrHPV types may be candidates for surveillance-based co-testing rather than immediate colposcopy, potentially enabling a resource-efficient reduction in unnecessary procedures within the biopsied cohort studied.