The long and winding road: the resilience of cervical cytology as a long-standing laboratory tool to aid the diagnosis of HPV-induced lesions

BACKGROUND: Despite molecular advancements, cervical cytology remains a resilient and fundamental laboratory tool in the prevention of cervical cancer. SUMMARY: This article revisits the historical trajectory of knowledge about HPV, from the first descriptions of genital warts to the consolidation of the virus as a necessary etiological agent of cervical carcinogenesis. The central role of the Papanicolaou test in the early detection of precursor lesions is highlighted, as well as the importance of morphological recognition of koilocyte as a cytopathological marker of HPV infection. The inherent limitations of conventional cytology are discussed, including observer-dependent variability, and the strategies that have reinforced its diagnostic quality, such as liquid-based cytology, quality control, automation, artificial intelligence, and integration with molecular HPV tests. Key-message: Finally, the work emphasizes that the combination of cytology and molecular methods, including p16/Ki-67 tests and DNA methylation, reinforces the continued relevance of cytology as an essential and adaptable pillar of modern cervical cancer screening programs.