Colposcopic biopsy findings in ASCUS or normal cervical cytology patients with high-risk HPV positivity

The aim of the present study was to compare colposcopic biopsy results of women in Turkey with normal cervical cytology and Atypical Squamous Cells of Undetermined Significance (ASCUS) who had human papilloma virus (HPV) genotypes 16, 18 and combined 16/18. The overarching goal was to enhance the existing body of evidence on cervical cancer screening strategies, with an ultimate aim of refining HPV testing guidelines and improving patient management. In this retrospective study, we examined the medical records of 1121 patients from a tertiary health care setting who tested positive for HPV 16, HPV 18 or both, and who exhibited ASCUS or normal Pap smear findings. A detailed review of the patients' colposcopic biopsy outcomes was conducted, with particular attention to their HPV genotype status and the impact of smoking. The 1121 patients were classified based on HPV genotype into three groups: HPV 16 (78.5%), HPV 18 (15.8%), and co-infection with HPV 16 and 18 (5.7%). On the basis of smear characteristics, patients were categorized as normal (81.4%) and ASCUS (18.2%). Approximately 40% of patients infected with HPV 16, HPV 18 or both with no evidence of intraepithelial lesion or malignancy (NILM) or ASCUS on Pap smear had High-grade Squamous Intraepithelial Lesion cancer on biopsy. Notably, for those with normal smear results, the rate of Low-grade Squamous Intraepithelial Lesion biopsy was approximately 15% higher in the HPV 18 group than the HPV 16 group (59.6% vs. 45.8%; p = 0.023). Smoking prevalence was significantly higher in the co-infected HPV 16/18 group (p = 0.013). This study underscores the importance of vigilant HPV and cytology testing, especially for individuals with HPV 16/18, regardless of normal cytology findings.