Retrospective analysis of cervical screening abnormalities in women with type 3 transformation zone without visible lesions

Among women with abnormal cervical screening and no visible lesions at type 3 transformation zone, HSIL+ risk varies by cytology, HPV genotype, and age. Our findings suggest that immediate diagnostic evaluation is warranted for those with high-grade cytology, HPV 16/18 with LSIL, and women aged ≥ 65 years with low-grade cytology and non-16/18 HPV, as their HSIL+ risk exceeds the 4% threshold recommended by current US guidelines. Conversely, women under 65 with low-grade cytology and non-16/18 HPV, or those with NILM/ASCUS and HPV 16/18, may be appropriate candidates for conservative follow-up. These results support a more tailored, risk-based approach to management in this challenging population.