ArticleCytopathology : official journal of the British Society for Clinical Cytology2026
From HSIL to SCC: A Real-World Analysis of Diagnostic Upgrade Pathways and Pitfalls in Cervical Cytology.
Article in Cytopathology : official journal of the British Society for Clinical Cytology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
contextCervical cancer remains a major global health concern. Liquid-based cytology (LBC) is a cornerstone of screening, but its diagnostic accuracy for high-grade lesions, particularly in specific populations such as Southern China, requires ongoing evaluation.
objectiveTo evaluate the diagnostic accuracy of LBC for high-grade squamous intraepithelial lesion (HSIL) and squamous cell carcinoma (SCC) in a large Chinese cohort, and to analyse associated human papillomavirus (HPV) genotype patterns and diagnostic pitfalls.
designRetrospective analysis of 518,519 LBC records (2014-2024), focusing on 1758 cases diagnosed as HSIL, HSIL suspected SCC, or SCC.
resultsThe detection rate for HSIL/SCC was 0.34%. Histopathological follow-up was available for 1315 cases. The concordance rates between cytology and histology were 44.5% for HSIL and 78.5% for SCC. All 52 cases labelled "HSIL suspected SCC" were confirmed as invasive SCC (positive predictive value [PPV] = 100%). Among discordant cases, 21.9% of cytological HSIL were upgraded to SCC on histology, while 67 cases originally diagnosed as HSIL/SCC were reclassified as other malignancies (e.g., adenosquamous carcinoma). HPV genotypes 16, 58, 52, and 33 were predominant (70.0% in HSIL, 81.0% in SCC). A small proportion (2.3%) of high-grade lesions were HPV-negative.
conclusionLBC demonstrates high specificity for SCC and useful predictive value for the "HSIL suspected SCC" category. However, diagnostic challenges remain, including under-recognition of invasive carcinoma in HSIL cases and misclassification of non-squamous malignancies. These findings underscore the importance of cytological expertise and the complementary role of HPV testing within screening programs.
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