How successful are pap smear cytology and human papillomavirus DNA test in detecting high-grade squamous intraepithelial lesions in perimenopausal women?

Objectives: The World Health Organization and European Union are eager to eradicate cases of cervical cancer. Human papillomavirus (HPV) infection is the main cause of cervical cancer. A co-test consisting of high-risk HPV (hrHPV) DNA testing and Pap smear cytology is being performed in our center. Perimenopausal changes in cervical cytology can be worrisome, suggesting the presence of squamous intraepithelial lesions (SILs). In this study, we wanted to assess the value of hrHPV DNA testing and Pap smear cytology in the detection of high-grade SILs (HSILs). Material and Methods: A retrospective analysis of patients aged between 45 and 50 years was carried out. Between April 2021 and November 2024, cases who have undergone loop electrosurgical excision, conization, or biopsy of the cervix have been included in our study. Cases with priorly available Pap smear and HPV DNA test results were selected. Three different liquid-based cytology preparation methods were used during the time period involved in this study. Results: A total of 131 female cases were included in our study. The histopathological diagnoses were chronic or atrophic cervicitis in 12 (9.2%), low-grade SIL (LSIL) in 95 (72.5%), and HSIL in 24 (18.3%) cases. Of 24 HSIL cases, 16 were hrHPV DNA test positive. Pap smear test results of HSIL cases revealed 9 cases with atypical squamous cells of undetermined significance or LSIL, 8 cases with atypical squamous cells that could not exclude high-grade SIL (ASC-H) or LSIL+ASC-H, and 7 cases negative for intraepithelial lesion or malignancy (NILM). Seven HSIL cases with ≥ASC-H Pap smear result demonstrated HPV DNA-negativity. Six HSIL cases with positive HPV DNA test had a NILM Pap smear cytology result. Four of these discordant cases were signed out while a non-Food and Drug Administration-approved methodology was used. Conclusion: A proper methodology is essential for a high-standard Pap smear analysis. If only the HPV DNA test was used for screening, 7 HSIL cases would be missed. We believe that performing both tests concurrently provides the clinician invaluable data in the detection of cervical lesions.