Colposcopy Outcomes in Women with First Episode of Borderline Squamous Cells Cytology and High-risk Human Papillomavirus Positivity: A Retrospective Cohort Study
Rajalakshmi RajagopalAbstract
BACKGROUND:
Early identification of abnormal changes is important in cervical cancer prevention. This study evaluated the colposcopic findings among women referred with first episode of borderline squamous cells cytology and high-risk human papillomavirus (HR-HPV) positivity.
METHODS:
This retrospective cohort study was conducted among women attending the National Health Service (NHS) cervical screening program in NHS Lanarkshire after the introduction of HPV Screening in March 2020. All the women who were referred to the colposcopy clinic between January 2023 and December 2023 with the first episode of borderline squamous cell changes with HR-HPV positivity were analyzed.
RESULTS:
Of the 390 women, most were between 25 and 30-year age group (32.3%), experiencing their first HPV-positive episode (≈75%), and 28.1% were vaccinated; 367 (94.1%) attended colposcopy, where low-grade colposcopic impression 131/367 (35.7%) and HPV-related changes (29.4%) were detected. Colposcopy directed biopsy performed in 274 cases (70.26%) detected low grade neoplasia(39.38%), high grade neoplasia (19.3%) and carcinoma(3 cases). Initial management was conservative in the majority (79.6%) of women.
CONCLUSIONS:
Among women referred with a first episode of borderline squamous cell cytology and HR-HPV positivity, high-grade cervical disease was uncommon, and most of them had low-grade or HPV-related abnormalities, which was managed conservatively. Nevertheless, the detection of a small number of invasive, high-grade (HG), and glandular lesions highlights the continued importance of timely referral, high-quality colposcopy, and appropriate biopsy to ensure early diagnosis and appropriate management. The predominance of smokers among fully vaccinated women highlights the continued importance of smoking as a modifiable risk factor.