Aksahin E, et al. J Gynecol Oncol. 2025 Aug;37:e6. https://doi.org/10.3802/jgo.2026.37.e6

Background and Objectives: In women who are positive for high-risk human papillomavirus (hrHPV), abnormal cytology necessitates colposcopy and biopsy; however, cytology–histology concordance is variable and may differ by menopausal status. This study aimed to evaluate the concordance between cytologic findings and biopsy results in hrHPV-positive women with abnormal Pap tests and to compare outcomes by menopausal status. Materials and Methods: This retrospective, single-center study included 904 hrHPV-positive women with abnormal cytology who underwent colposcopy. Cytology findings [atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), atypical squamous cells—cannot exclude high-grade squamous intraepithelial lesion (ASC-H), and high-grade squamous intraepithelial lesion (HSIL)] were compared with histological findings [normal, cervical intraepithelial neoplasia (CIN)-1, -2, -3]. Menopausal status was stratified as premenopausal (<48 years) and postmenopausal (≥48 years). Rates of cyto-histologic concordance, overestimation, and underestimation were calculated. Results: The predominant cytological result was ASC-US (61.7%), followed by LSIL (25.3%), whereas histologically, CIN was most common (66.5%; CIN-1: 42.8%, CIN-2: 11.5%, CIN-3: 12.2%). Cytology–biopsy concordance was 50.7%, with overestimation in 35.4% and underestimation in 13.9%. Overestimation was highest in ASC-US (43.9%) and ASC-H (37%), while underestimation was most frequently seen in LSIL cases (27.1%). HSIL cytology showed the highest agreement (85.7%). Conversely, LSIL cytology showed higher cyto-histologic concordance in postmenopausal women, whereas ASC-H and HSIL cytologies were more commonly overestimated in comparison to premenopausal women. Using ASC-H/HSIL as the positive cytology threshold for CIN-2+ detection, sensitivity was 41.1% and specificity was 95.8% [positive predictive value (PPV) 75.2%, negative predictive value (NPV) 84.0%; overall accuracy 82.9%]. The sensitivity and NPV were higher in postmenopausal women than in premenopausal women (50.0% vs. 39.9%; 91.3% vs. 82.3%, respectively). Conclusions: Cytology–histology concordance is moderate among women who are hrHPV-positive with abnormal cytology, characterized by notable underestimation in low-grade cytology and strong predictive value in HSIL cases. Menopausal status influences the outcomes; in postmenopausal women, high-grade lesions are less frequent, and diagnostic accuracy for detecting CIN-2+ is higher. These findings highlight the need for age- and menopause-sensitive diagnostic approaches.

Aims: To evaluate the diagnostic and therapeutic role of colposcopy in patients with negative cervical cytology but positive for high-risk human papillomavirus (hrHPV) types other than HPV 16 and 18, in light of current guideline recommendations. Methods: This retrospective study included 428 women aged 21-65 who underwent colposcopy at a tertiary care center between June 2020 and December 2024. All patients had negative cytology and tested positive exclusively for high-risk HPV types other than HPV 16/18. Cervical biopsy and endocervical curettage (ECC) were performed during colposcopy. Histopathological evaluations were conducted by experienced gynecologic pathologists using the Lower Anogenital Squamous Terminology (LAST) system. Demographic and clinical data were recorded and analyzed using SPSS version 27. Results: Among the 428 patients, 281 (65.7%) had no dysplasia, 126 (29.4%) had CIN 1, 15 (3.5%) had CIN 2, and 6 (1.4%) had CIN 3. No cases of invasive cervical cancer were detected. ECC results showed CIN 1 lesions in 11 patients (2.6%) and no high-grade lesions. The overall rate of CIN2+ lesions was 4.9%. Most patients with CIN2+ lesions were multiparous, premenopausal, and had a mean age of 40 years. Conclusion: Current ASCCP guidelines recommend follow-up with co-testing after one year for patients with negative cytology and non-16/18 hrHPV positivity. However, the 4.9% rate of CIN2+ lesions observed in this study suggests that immediate colposcopy may be clinically beneficial in this patient group. Especially in populations with low adherence to follow-up, colposcopy may represent an alternative management approach.

Background/Objectives: To evaluate whether complete metabolic response (CMR) on 18F-FDG PET/CT after neoadjuvant chemotherapy (NACT) is associated with complete cytoreduction at interval debulking surgery (IDS), progression-free survival (PFS), and overall survival (OS) in patients with advanced high-grade serous tubo-ovarian carcinoma. Methods: This retrospective single-center cohort included 87 patients with FIGO stage III–IV high-grade serous carcinoma undergoing 18F-FDG PET/CT before and after NACT. Metabolic response was classified as CMR or non-CMR using criteria adapted from PERCIST. The primary outcome, complete cytoreduction (R0), was assessed using multivariable logistic regression adjusted for age, FIGO stage, and number of NACT cycles. PFS and OS were analyzed from the interval debulking surgery (IDS) landmark using the Kaplan–Meier method, and PFS was further evaluated with Cox regression. Results: CMR was observed in 34 patients (39.1%). Complete cytoreduction was achieved in 62 (71.3%) and was more frequent with CMR (85.3% vs. 62.3%; p = 0.025). CMR was independently associated with R0 (adjusted OR 3.56, 95% CI 1.18–10.75; p = 0.024; sensitivity 46.8%, specificity 80.0%, PPV 85.3%). In the IDS-landmark analysis, median PFS was longer in the CMR group (12.9 vs. 9.1 months; p = 0.027), but this association was attenuated and no longer significant after adjustment for R0. OS did not differ significantly between the groups (p = 0.259). Conclusions: Post-NACT CMR was independently associated with complete cytoreduction and may support preoperative risk stratification. However, given its limited sensitivity, CMR should not be used as the sole determinant for IDS.

Background/Objectives: High-risk human papillomavirus (hrHPV) positivity and its management may affect sexual function and psychological well-being, yet whether this burden differs across the successive steps of cervical management is unclear. We compared sexual function, quality of life, and psychological distress across three management steps—surveillance, colposcopy, and loop electrosurgical excision procedure (LEEP). Methods: In this single-center cross-sectional study, 302 reproductive-age women with a history of hrHPV positivity (surveillance, n = 50; colposcopy, n = 177; LEEP, n = 75) completed the Female Sexual Function Index (FSFI), WHOQOL-BREF, and Hospital Anxiety and Depression Scale (HADS). Groups were compared with Kruskal–Wallis and chi-square tests; FSFI total was modelled by multivariable linear regression and FSFI-defined dysfunction by logistic regression. Results: No statistically significant between-group differences were observed in FSFI total (medians 23.8/25.2/24.5; p = 0.897), FSFI subdomains, HADS, or WHOQOL domains; FSFI-defined dysfunction was frequent across groups, with no statistically significant between-group difference (59–67%). No statistically significant association between management pathway and FSFI was observed in the adjusted models (LEEP vs. surveillance B = −0.63, 95% CI −4.68 to +3.42). Depressive symptoms—but not anxiety—were associated with FSFI-defined dysfunction (per HADS-D point, OR = 1.14, 95% CI 1.03–1.26, p = 0.009), whereas the association with continuous FSFI was not significant (B = −0.37, p = 0.064). Marital status was the strongest overall correlate. Conclusions: Across surveillance, colposcopy, and LEEP, sexual function did not differ significantly between management groups at the time of assessment, and, in exploratory analyses, depressive symptoms showed the most consistent association with sexual dysfunction. These findings highlight the potential relevance of psychosocial and relational context in the psychosexual care of women with a history of hrHPV positivity, although prospective studies are needed before specific screening or counselling recommendations can be made.