Cervical pathology outcomes in the setting of completely normal colposcopic impressions

To investigate the pathological outcomes in patients referred for colposcopy due to abnormal cervical cancer screening results while presenting completely normal colposcopic impressions. This retrospective study was conducted at the Cervical Disease Diagnosis and Treatment Health Center of Fujian Maternity and Child Health Hospital (a tertiary referral center in Southeast China). We included 2,515 patients with abnormal screening (cytology/HPV) but completely normal colposcopy. All underwent four-quadrant cervical biopsies. Endocervical curettage (ECC) was added for HPV16/18-positive cases, high-grade cytology, or partially visualized squamocolumnar junctions (SCJ). Conization/hysterectomy was performed per clinical guidelines. Pathological diagnosis relied on the most severe findings across cervical biopsies, ECC, conization and hysterectomy specimens. High-grade squamous intraepithelial lesions or worse (CIN2+) were detected in 7.1% (179/2515), including 7 cervical cancers (all postmenopausal, aged >45, with partially visualized SCJ). Biopsies confirmed 72.1% (129/179) of CIN2+ cases, while 20.1% (36/179) were identified via ECC and 7.8% (14/179) via conization. CIN2+ risk correlated with advanced age (P=0.011) and high-risk screening results (P<0.001). Menstrual status, cervical transformation zone type, gravidity, and parity showed no significant differences between CIN2+ and normal/CIN1 groups. The presence of CIN2+ lesions cannot be ruled out based solely on completely normal colposcopic impressions. High-risk screening results and advanced age are associated with an increased risk of CIN2+. Random biopsies, alongside ECC when the SCJ is partially visualized, play a crucial role in detection, particularly among postmenopausal patients. However, for patients under 25 with low-risk screening results, such procedures may not be imperative.