Twelve-year trends in cervical cytology screening: a retrospective analysis of 83,148 smears from a Turkish tertiary care center

Introduction Cervical cancer screening through cytology and human papillomavirus (HPV) testing is essential for early detection of precancerous lesions, yet long-term institutional data integrating cytological trends, HPV genotype epidemiology, and diagnostic performance from Turkey remain limited. This study aimed to analyze the distribution and temporal trends of cervical cytological abnormalities, HPV prevalence and genotype distribution, and cytology-histopathology concordance over a 12-year period at a tertiary care center in Istanbul. Methods A retrospective analysis of all cervical smear samples collected between January 2014 and December 2025 was conducted. Cytology results were classified according to the Bethesda 2014 system. HPV testing, which was performed on a subset of the study population based on clinical indications and kit availability, included mRNA-based assay (Aptima, 2020–2021, n = 4,648) and DNA genotyping (2024–2025, n = 4,308). Cytology-histopathology correlation was assessed for cases with biopsy within 180 days. Results Among 83,148 cervical smear records, 76,232 evaluable results from women aged ≥21 years were included. The overall epithelial cell abnormality rate was 7.93%, with atypical squamous cells of undetermined significance (5.83%) and low-grade squamous intraepithelial lesions (1.77%) being the most common findings. Epithelial cell abnormality rates varied significantly across age groups, with the highest rate in the 18–20 age group (12.78%) and a significant inverse correlation with increasing age ( r = −0.955, p < 0.001). Among tested patients, HPV positivity was 9.1% by mRNA testing and 9.9% by DNA genotyping, with HPV-16 predominating in both methods (20.5 and 32.8% of positive cases, respectively). Notably, HPV-56 (16.6%) and HPV-51 (14.3%) were more prevalent than HPV-18 (8.9%). High-grade squamous intraepithelial lesion cytology demonstrated a positive predictive value of 89.2% for detecting cervical intraepithelial neoplasia grade 2 or higher. A significant decrease in epithelial cell abnormality rates was observed over the study period ( r = −0.591, p = 0.043), with a more pronounced decline in high-grade abnormalities ( r = −0.911, p < 0.001). Conclusion The 12-year analysis shows a decrease in cervical cytological abnormalities and provides valuable epidemiological data on HPV genotype distribution in a Turkish population. The high prevalence of non-vaccine-targeted genotypes, such as HPV-56 and HPV-51, should be considered in future vaccination strategies.