Background/Objectives: To evaluate the effectiveness of expectant management on grades 1 and 2 cervical intraepithelial neoplasia (CIN), including factors associated with regression and progression. Methods: This multicenter study included 561 women managed expectantly and 359 who underwent immediate surgery at eight institutes between 2013 and 2023. Results: Over a 4-year period, 63% and 68% of CIN 1 and CIN 2 cases regressed, and 9% and 14% of cases progressed, respectively. The median regression times were 1.5 years for CIN 1 and 1.2 years for CIN 2. High-risk human papillomavirus (HPV) types, especially HPV 58 (adjusted hazard ratio [HR]: 0.61; p = 0.032) and high-grade initial cytology, atypical squamous cells—cannot exclude high-grade squamous intraepithelial lesion (ASC-H) and high-grade squamous intraepithelial lesion (HSIL) (adjusted HR: 0.3, p < 0.001), were associated with a lower likelihood of regression. Also, hematological disorders reduced the likelihood of regression (adjusted HR 0.39, p = 0.045). In a separate analysis of the immediate surgery group, age in the 30s (p = 0.016) and HPV 16 infection (p = 0.005) were associated with pathologic upgrading at surgery. Conclusions: CIN 1 and 2 usually regress, allowing expectant management for up to 1.5 and 1.2 years, respectively. However, HPV 58 infection or high-grade initial cytology, and hematological disorders are indications for careful monitoring. Patients in their 30s or infected with HPV 16 have a higher risk of pathologic upgrading at surgery.

Objectives: Cervical cancer remains a major health concern worldwide. In women aged ≥ 50, diagnostic accuracy may be compromised due to menopausal changes such as atrophy and squamocolumnar junction displacement. Cytology remains the primary screening tool in many regions, including Poland, although its sensitivity and specificity are limited. This study assessed the concordance between cytological diagnoses of high-grade squamous intraepithelial lesions (HSILs); atypical squamous cells, which cannot exclude HSIL (ASC-H); atypical glandular cells (AGCs); and histopathological verification in women aged ≥ 50 years, highlighting the limitations of current diagnostic pathways. Methods: A retrospective analysis was conducted on women aged ≥ 50 years referred between 2018–2024 with abnormal cytology. All patients underwent colposcopic assessment followed by histopathological verification supported by p16 immunostaining. Cytological and histopathological results were compared. Associations between clinical variables and diagnostic concordance were tested using the chi-square test (α = 0.05). Results: Among 79 patients, histopathology confirmed high-grade squamous intraepithelial lesions with cervical intraepithelial neoplasia grade 2 or higher (HSIL/CIN2+) in 38%. Low-grade squamous intraepithelial lesions with cervical intraepithelial neoplasia grade 1 (LSIL/CIN1) were found in 11%, and vaginal intraepithelial neoplasia grade 1 (VAIN1) in 4%, while 47% demonstrated inflammatory changes or no abnormalities. HSIL cytology showed the highest concordance, whereas AGC was more frequently associated with benign findings. No statistically significant association was detected between cytology accuracy and clinical characteristics (p > 0.05), highlighting the need for further studies in larger cohorts. Conclusions: In women aged ≥ 50, abnormal cytology frequently overestimated the severity of cervical pathology. Reliance on cytology alone may lead to overtreatment or misclassification, particularly in the presence of atrophic or inflammatory changes. Complementary use of human papillomavirus (HPV) genotyping and molecular markers alongside histopathological verification is recommended to enhance diagnostic precision in this population.

The aim : to assess the prevalence and genetic diversity of high-risk human papillomavirus (hrHPV) in intraepithelial lesions of the cervix of varying severity in women (using the Gomel region as an example). Materials and methods . Cytological examination and testing for HPV were carried out from 2018 to 2021 using the Abbott RealTime hrHPV kit for high-risk HPV on the Abbott m2000sp device. This test separately detects HPV 16, HPV 18 and a pool of 12 additional hrHPV types, further genotyping was carried out using the AmpliSens hR HPV genotype-FL reagent kit (Russia). Material — scrapings from the cervical canal. 11 146 women from the Gomel region were examined. Results . According to the results of the studies, high-grade dysplasia (HSIL) was noted in 1.0% of cases, low-grade dysplasia (LSIL) — in 1.3% and atypical squamous cells of unknown significance (ASC-US) — in 1.8% of samples. A significant relationship between HPV and cervical dysplasia of varying degrees was established. In severe cervical dysplasia, HPV type 16 was identified in 69.2% of cases (p=0.027). In mild cases, type 45 was detected in 18% (p=0.001) and type 56 in 22.0% (p=0.010). The proportion of HPV 18 (18.5%) was significantly higher in the group of women with a normal cytogram (p < 0.001). No statistically significant differences in the frequency of occurrence of other HPV genotypes were found. In women of the Gomel region, with varying degrees of dysplasia, the dominance of HPV of the phylogenetic group a9 was noted, while in the group of women with HSIL, their share was maximum — 82.4%. HPV-associated dysplasia of the cervix was detected in 51% of women of reproductive age (p < 0.001). Conclusion . The relationship between high-risk carcinogenic HPV and the development and progression of cervical intraepithelial dysplasia of the cervix has been demonstrated. It has been established that the genetic landscape of dominant HPV variants differs in women with different degrees of cervical dysplasia. Among women with cervical dysplasia, the dominance of HPV of the phylogenetic group a9 was noted, which was maximally represented in the group with HSIL. HPV screening and liquid cytology are important components of the program for early detection of neoplastic processes aimed at preventing cervical diseases caused by HPV.

As the first vaccinated cohorts are gradually becoming eligible for cervical cancer screening (CCS), changes in the distribution of high-risk human papillomavirus (hrHPV) infection and associated disease endpoints are expected to occur. We aimed to describe the clinical outcomes of the Regional CCS Program of the North of Portugal in the latest years and to estimate the impact of different hrHPV genotypes on the occurrence of cervical neoplasia. Secondary data collected from the Regional CCS Program of the North of Portugal between January 2019 and December 2024 was used. Descriptive analysis was performed, and the proportion of high-grade squamous intraepithelial lesion (≥HSIL) attributable to different hrHPV genotypes was estimated. Between January 2022 and December 2024, the prevalence of hrHPV infection was 14.1%, and multiple infections accounted for 28.4% of the cases. Overall, the most prevalent genotypes were HPV-68 (16.6%), HPV-52 (14.5%), and HPV-31 (13.3%). Among the samples that underwent cytological analysis, 14.8% were atypical squamous cells of undetermined significance, 7.2% were low-grade squamous intraepithelial lesion, and 3.9% were ≥HSIL. Between 2019 and 2024, there was a decrease in the prevalence of the hrHPV genotypes included in the quadrivalent vaccine (17.5%-11.4%), especially in the youngest females, who also experienced a decrease in the frequency of ≥HSIL (6.0%-2.4%). The proportion of ≥HSIL attributable to these hrHPV types decreased from 38.5% to 23.5% in the youngest females, and no significant variations were found for the remaining. This study highlights the considerable reduction of the prevalence of both hrHPV infection and associated cervical abnormalities among the youngest and presumably vaccinated cohorts.

Beyond the transformation zone: Outcomes in the management of CGIN over five years.

On May 14, 2024, the US Food and Drug Administration (FDA) approved self-collected vaginal samples for human papillomavirus (HPV) testing, expanding cervical cancer screening access. To evaluate the feasibility and acceptability of HPV self-collection through community outreach programs targeting underscreened populations in Oregon. From October 2024 to June 2025, women aged 25 to 65 years were recruited through local organizations. Following instruction by pathologists, participants completed self-collection by using Copan swabs, which were transferred to ThinPrep media for high-risk HPV testing using the Cobas 8800 system. Postcollection surveys assessed user experience. Among 156 participants (mean age, 47.1 years), 87 (55.8%) identified as Hispanic and 69 (44.2%) as non-Hispanic. Racial groups included Hispanic White (87; 55.8%), Asian (33; 21.1%), Black (16; 10.3%), non-Hispanic White (14; 9.0%), Pacific Islander (2; 1.3%), and nondisclosed (4; 2.5%). All tests were valid; 10 participants (6.4%) were HPV-positive, including 1 with HPV-18 and 9 with non-16/18 types. Follow-up cytology showed 1 case of atypical squamous cells of undetermined significance and 2 negative results; the remainder are pending follow-up. Of 129 survey respondents, 8 (6.2%) had received the HPV vaccine. Overall, 117 (90.7%) found the self-collection kit easy to use, 114 (88.4%) would recommend it, and 91 (70.6%) were likely to choose self-collection over clinician-collected samples for future testing. Common feedback included convenience, comfort, and privacy. HPV self-collection is a practical, user-friendly, and accessible screening option. Pathologist-led outreach may help close screening gaps. This study represents the first academic center-led implementation of FDA-approved self-collection in US community settings.

Objective.To systematize the morphological characteristics of cervical intraepithelial neoplasia (CIN) in the context of human papillomavirus infection (HPV)-associated pathology through a literature review and analysis of clinical and morphological data.Materials and Methods.The study included 40 cervical biopsy specimens obtained from patients with precancerous cervical conditions examined at the Department of Pathological Anatomy, University Medical Center. Histological evaluation was performed using hematoxylin–eosin staining. Clinical and laboratory data were integrated, including Pap smear results, HPV genotyping, and screening for sexually transmitted infections (STIs).Results.HPV type 16 was the most frequently detected genotype (14 cases). Coinfections with two HPV genotypes were observed in 9 patients (e.g., 16 and 45, 18 and 51), while 3 patients had triple infections. Sixteen cases were HPV-negative. High-grade CIN (CIN 2, CIN 3, or carcinoma in situ) was diagnosed in 19 of 40 patients (47.5%), even though cytology revealed only low-grade lesions (LSIL) or atypical squamous cells of undetermined significance (ASC-US). Additionally, 4 cases (10%) with NILM (negative for intraepithelial lesion or malignancy) on cytology demonstrated CIN I–II on histology. STIs were identified in 26 patients (65%), predominantly Gardnerella vaginalis (55%), followed by Cytomegalovirus (17.5%), Candida albicans (10%), and Mycoplasma hominis (7.5%), including mixed infections. These findings indicate a high prevalence of HPV and concurrent STIs among patients with CIN, as well as notable discrepancies between cytological and histological diagnoses, particularly in the presence of inflammatory processes.Conclusions.The study underscores the limitations of cytological screening and the importance of comprehensive diagnostic strategies combining morphological, clinical, and molecular methods. Standardization of morphological criteria for CIN is essential, particularly in HPV-associated and inflammation-related contexts, to improve diagnostic accuracy and patient management.Keywords:cervical intraepithelial neoplasia, HPV, cytology-histology correlation, sexually transmitted infections, morphology.

Persistent infection with high-risk human papillomavirus (hrHPV) is recognized as the primary cause of cervical cancer and its precancerous lesions. However, most HPV infections are transient and naturally clear. Currently effective triage tools for distinguishing between transient HPV infections and clinically relevant hrHPV-induced diseases are lacking, leading to excessive referrals and overtreatment. This is the first large-scale, prospective, multicenter study to evaluate the triage performance of host DNA six-methylation marker assay (ASTN1, DLX1, ITGA4, RXFP3, SOX17, and ZNF671) in women who are hrHPV-positive in China. Compared with HPV genotyping and cytology [≥ atypical squamous cells of undetermined significance (ASCUS)] screening, the six-methylation marker assay demonstrated superior triage performance, with sensitivities of 82.2% and 90.3% and specificities of 92.4% and 84.1% for cervical intraepithelial grade II/III and worse (CIN2+ and CIN3+), respectively. Further subgroup analysis of women <30 years of age revealed its efficacy. The methylation positivity rate increased with the severity of cervical lesions, and the most significant marker was ZNF671. Moreover, the six-methylation marker assay required the fewest colposcopy referrals, with only 1.32 and 2.39 per CIN2+ and CIN3+ cases, respectively, highlighting its strong health and economic advantages. The large number of women with HPV infections in China each year has led to excessive cytological screenings and colposcopy referrals. A feasible triage tool for women who are hrHPV-positive significantly reduces unnecessary medical resource utilization and offers substantial health and economic benefits.

PurposeHigh-risk human papillomavirus (hr-HPV) types are the primary cause of cervical and anogenital cancers. Understanding patterns of persistence, clearance, and re-infection is essential, as persistent infections contribute to precancerous and invasive lesions. This study evaluated hr-HPV infection dynamics and genotype specific outcomes over two years among Ethiopian women.Patients and MethodsA cohort of 893 women aged 30–49 years was followed for two years using self-collected samples for multiplexed hr-HPV genotyping by BSGP5+/6+ PCR. Women testing positive were re-evaluated at 6 and 24 months with HPV genotyping, Visual Inspection with Acetic Acid (VIA) and cytology. Persistent infection was defined as continuous HPV DNA presence over consecutive visits, while clearance indicated no detectable virus. Re-infection occurred if a cleared HPV type reappeared, or a new type was detected.ResultsAfter six months, 26.3% had persistent infections, while 73.7% cleared the infection. After two years, 13.2% experienced persistence, and 86.8% cleared their infections. Among women who tested negative at baseline, 74 were re-tested and showed hr-HPV incidence of 4.05% after 24 months. Genotype persistence rates varied, with HPV68, 82, 53, 52, and 56 showing the highest persistence after six months. After 24 months, HPV59, 68, 66, 52, and 16 had the highest persistence. Additionally, 29.9% of women at six months had abnormal cytology, including Atypical squamous cells of undetermined significance (ASCUS) and High grade squamous intraepithelial lesion (HSIL), which was 10.3% of those tested.ConclusionThe findings show that most hr-HPV infections among rural Ethiopian women cleared within two years, with varying persistence and clearance rates across HPV types. This emphasizes the need for regular monitoring and targeted prevention in high HPV prevalence populations.

Urothelial carcinoma with squamous differentiation (UCSD) carries adverse outcomes, yet cytological recognition is challenging because keratinized atypical squamous cells (ASCs) often show deceptively low nuclear-to-cytoplasmic ratios. A size-based ASC classification anchored to neutrophils was evaluated as a biological internal reference. All cytology specimens were prepared with the ThinPrep liquid-based cytology system. Seventeen urine cytology specimens from histologically confirmed UCSD and 79 cytologically benign (BE) specimens with squamous cells were retrospectively reviewed. ASCs with orangeophilic cytoplasm were subclassified by nuclear size relative to the adjacent neutrophils: ASC-S (small nuclei; >1× neutrophil) and ASC-L (large nuclei; >2× neutrophil). Counts were obtained from five high-power fields. UCSD was stratified by the extent of squamous differentiation (<50% vs.≥50%). No ASC-S/L was identified in BE specimens, whereas either subtype was present in 15 of the 17 UCSD cases, which yielded a cohort-level sensitivity of 88% and specificity of 100% for UCSD detection (95% CI, 65.7%-96.7% and 95.4%-100%, respectively). ASC-S was more prevalent than ASC-L, and was observed across Paris System categories-including atypical urothelial cells (AUCs)-whereas ASC-L appeared mainly in suspicious for high-grade urothelial carcinoma/high-grade urothelial carcinoma. ASC-S counts tended to increase with greater histological squamous differentiation, and were detectable even when tissue involvement was <50%. Neutrophil-calibrated ASC classification provides an objective, biologically grounded framework that aligns cytology with histology in UCSD. Reporting ASC-S/L-particularly ASC-S in equivocal (AUC) specimens-may facilitate earlier recognition of squamous differentiation and inform subsequent tissue evaluation. Prospective, multi-institutional validation with interobserver agreement and receiver operating characteristic-based thresholds is warranted.

BackgroundAlthough minor cytological abnormalities predict a low risk of high-grade lesions, their high reporting rates lead to a considerable number of high-grade lesion cases. We carried out this study to analyze the immediate risk and 5-year cumulative risk of high-grade cervical lesions in high-risk human papillomavirus (Hr-HPV)-positive patients with minor cytological abnormalities and to investigate the clinical significance of minor cytological abnormalities during follow-up in our single-center.MethodsA total of 1892 patients with positive Hr-HPV, cytology result of atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesion (LSIL) and also underwent colposcopy and biopsy were selected to analyze the immediate risk of high-grade cervical lesions. Besides, a total of 832 patients with baseline histological results of CIN1 or below and 5-year follow-up data available were further used to analyze the 5-year cumulative risk of high-grade cervical lesions.ResultsThe immediate incidence rates of CIN3 + in the ASC-US and LSIL groups were 6.27% (63/1005) and 5.64% (50/887), respectively. When CIN3 + was used as the study endpoint, the multivariate logistic regression analysis indicated that there was no significant difference in either the immediate risk or the 5-year cumulative risk of CIN3 + between the ASC-US and LSIL groups.ConclusionsIn summary, since both the immediate and 5-year follow-up risks for CIN3 + were similar in patients with ASC-US and LSIL, routine follow-up should be performed in minor cytological abnormalities, regardless of whether the cytology result is ASC-US or LSIL. Through the risk assessment of Hr-HPV and cytology combined screening, the 2019 ASCCP guidelines were suitable for cervical cancer screening at our single center.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12885-025-14972-6.

Objective: This study aimed to identify risk factors associated with high-grade cervical intraepithelial neoplasia (CIN3+) in young adults with abnormal Pap smears. Methods: We performed a retrospective chart review of women ≤30 years who underwent loop electrosurgical excision procedure (LEEP) for abnormal Pap results (atypical squamous cells of undetermined significance [ASCUS] or higher), between 2012 and 2022 at Dongtan Sacred Heart Hospital. Clinical characteristics, including age, HPV infection, prior gynecologic surgery, pelvic inflammatory disease (PID), complete blood count, and Pap smear screening history were collected. Women with CIN3+ based on punch biopsy or LEEP were designated as CIN3+. Results: A total of 158 women underwent LEEP. Of these, 61.4% were diagnosed with CIN3+ and 8.2% with invasive cervical cancer. Independent predictors of CIN3+ included age >28 years, smoking, lack of regular Pap screening, and high-risk HPV infection. Subgroup analysis suggested age ≥28 years and neutrophil-to-lymphocyte ratio >2.12 were risk factors for invasive cervical cancer. Conclusions: Young Korean women with abnormal Pap smears and risk factors such as older age, smoking, high-risk HPV infection, and irregular screening histories are at increased risk for CIN3+. These findings highlight the importance of timely intervention; however, because our cohort included only women who underwent LEEP, it may represent a higher-risk subset and thus introduce selection bias. Validation in larger multicenter, prospective studies incorporating fertility and recurrence outcomes are needed before definitive recommendations can be made.

Abstract Background The American Cancer Society’s 2020 guidelines recommend cervical cancer screening for individuals with a cervix aged 25-65 every five years with an HPV test. However, cervical cancer disproportionately affects under-screened populations, including migrant workers, immigrants, and underserved communities. In Oregon, these groups face language, cultural, and healthcare access barriers. To address these challenges, HPV screening must be accessible and culturally sensitive. In May 2024, the FDA approved HPV self-collection using the Cobas HPV Test (Roche Molecular Systems) in healthcare settings. This study aims to evaluate the effectiveness and accessibility of HPV self-collection for underserved communities. Methods This study, approved by the Institutional Review Board at Oregon Health &amp; Science University (OHSU), partnered with the Chinese Friendship Association of Portland (CFAP) to recruit women aged 25-65. Self-collection took place at CFAP’s free clinic, where pathologists guided participants through the process. Participants used Copan swabs (Copan Diagnostics, Murrieta, CA) for vaginal sample collection, which were transferred to ThinPrep media (Hologic, Marlborough, MA) for HPV testing using the Cobas 8800 system (Roche Diagnostics, Pleasanton, CA). Participants also completed questionnaires to provide feedback on the screening process. Results Twenty-eight Asian women, aged 28-62 (mean age 48.3), participated. The group included 1 Vietnamese, 3 from Myanmar, and the rest were Chinese. All self-collection samples were valid; 26 were negative for HPV, and 2 were positive for non-16/18 HPV types. Follow-up Pap smears revealed one normal result and one with atypical squamous cells of undetermined significance. A colposcopy confirmed cervical intraepithelial neoplasia grade 1 in one case, with follow-up recommended in one year. Seventeen participants completed the post-event survey. Four (23.5%) had received the HPV vaccine, and 3 were vaccinated at ages 20–21. When asked about their preference for self-collection, 64.7% of participants were very likely to choose it again, while 29.4% were likely to choose it. Only 5.9% were neutral. Regarding ease of use, 58.8% found the kit very easy, and 29.4% found it easy. Only 5.9% found it difficult. Forty-seven percent found the instructions very clear, while 35.3% felt they were clear. When asked if they would recommend the self-collection method, 58.8% were very likely to recommend it, and 29.4% were likely to recommend it. Feedback from the events was positive, with 41.2% appreciating the convenience and 29.4% praising the friendly, caring staff. Furthermore, 70.6% stated they would not have been able to access screening without the event, highlighting the importance of community-based initiatives. Conclusion This study demonstrates that HPV self-collection is an effective and accessible method for cervical cancer screening, particularly for underserved populations. The high preference for self-collection, positive feedback on ease of use and clarity, and the increased accessibility underscore its potential to improve early detection and reduce cervical cancer incidence in under-screened communities. Additionally, pathologists and laboratory staff play a critical role in leading outreach efforts that not only enhance access to screening but also reduce the overall cost of cervical cancer screening when compared to traditional co-testing and cytology-only methods.

High-risk HPV genotype distribution and prevalence in cervical swabs from Western Turkey.

PurposeThis study aimed to retrospectively evaluate the distribution of human papillomavirus (HPV) genotypes, age-specific prevalence, and their association with histopathological outcomes in women with cervical cytology results reported as atypical squamous cells of undetermined significance (ASC-US) and concurrent high-risk HPV (hr-HPV) positivity.Patients and MethodsAmong 39,189 records screened between October 2019 and October 2024, 705 patients with ASC-US and hr-HPV positivity were included. HPV genotyping was performed using real-time PCR, cytological evaluation followed the Bethesda System, and colposcopic biopsies were classified according to the Lower Anogenital Squamous Terminology (LAST) guidelines.ResultsHPV-16 (25.6%), HPV-51 (7%), and HPV-31 (6.5%) were the most prevalent genotypes, detected in 28.2% (n=199) of hr-HPV-positive cases. HPV-16 demonstrated the strongest association with high-grade lesions, accounting for 47.6% of cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Multiple HPV infections correlated with an elevated risk of CIN2+. Age-stratified analysis revealed HPV-16 predominance in women aged 40–49 years, whereas HPV-51 was more frequent in those ≥60 years.ConclusionIn ASC-US cases, HPV-16 is the predominant genotype and a significant predictor of high-grade cervical lesions. The unexpectedly high prevalence of HPV-51 and HPV-31 in this Turkish cohort underscores the importance of tailoring screening algorithms to regional genotype distributions. Furthermore, the observed age-specific variations in genotype prevalence highlight the need for age-adjusted management strategies.

To evaluate the performance of self and clinician collected samples for high-risk human papilloma virus (hr HPV) DNA detection and to assess the acceptance and attitude of women towards self-collection. This was a prospective single blind study done in 396 women (30-65 years) attending the gynecology outpatient department (OPD). Cervical swabs were collected in duplicate (self and clinician) in transport medium and stored at 4°C until further processing. A cervical smear was also collected at the same time. High risk HPV DNA was tested using real-time polymerase chain reaction (PCR). The samples positive for HPV DNA in any of the samples either self or clinician underwent a colposcpy guided biopsy. A total of 396 women underwent screening. A total of 8% women complained of post coital bleeding. Cervical smear was inadequate in 15% and atypical squamous cells of undetermined significance (ASCUS) and above was reported in 3.7% samples. Overall agreement between self and clinician sampled HPV (C-HPV) was 91.4% with Kappa unadjusted being 43.4% (95% CI: 35.8-51.1). Overall agreement between C-HPV and cervical smear was 79.5% with Kappa unadjusted of 19.2% (95% CI: 12.8-25.5). Overall agreement between self and cervical smear was 80.0% with Kappa unadjusted value of 21.7% (95% CI: 14.7 to 28.7). A total of 23 women underwent biopsy of which 19 were diagnosed with cervical intraepithelial neoplasia-1 (CIN-1) and above with a positive predictivity rate of 100% with either screening result being positive. HPV DNA self-sampling can be a major breakthrough in breaking the shackles of underutilization of cervical cancer screening and thus decrease the morbidity and mortality of cervical cancer.

Introduction: Cervical cancer is one of the most prevalent cancers amongst women worldwide. Early detection and appropriate management of cervical abnormalities are essential to prevent disease progression and enable timely treatment. This study aimed to compare the diagnostic findings of colposcopy and cervical biopsy in patients with atypical squamous cells of undetermined significance (ASC-US) on Pap smear. Methods: In this descriptive-analytical cross-sectional study, patients with ASC-US Pap smear results who underwent both colposcopy and cervical biopsy between 2019 and 2023 were evaluated. Variables including age, menopausal status, HPV infection, and clinical symptoms were compared across the two diagnostic methods. Result: A total of 400 patients, with a mean age of 37.4 years, were included in the analysis. Most Pap smears were performed before menopause, and high-risk HPV was the most detected type. The most frequent clinical finding was an abnormal cervical appearance. A significant relationship was observed between the type of neoplasia and both age and menopausal status, based on colposcopy and biopsy results. Among women under 50 years of age, 52.5% showed no dysplasia; in those over 50, this rate increased to 87.5%. Cervical intraepithelial neoplasia (CIN) was the most common type of dysplasia across all age groups. Amongst premenopausal women (90.5% of the cohort), 51.6% had no dysplasia and 39.6% had CIN I. In post-menopausal women (9.5%), 97.3% had no dysplasia, with only one case of CIN I. High-risk HPV accounted for 73% of infections, amongst whom 37% showed no dysplasia. Amongst patients with an abnormal cervical appearance (48.9%), 57.1% had no dysplasia and 21.4% had CIN I. Colposcopy demonstrated a sensitivity of 73% and a specificity of 77.64%. Conclusion: In patients with ASC-US Pap smear results, colposcopic findings related to the severity of dysplasia and type of neoplasia were significantly associated with age and menopausal status. However, no significant associations were found with HPV type or clinical symptoms.

Previous studies showed the association between sexually transmitted infections (STIs) and cervical lesions remains ambiguous. This study was conducted among 8371 women from a screening cohort. Seven specific sexually transmitted pathogens (STPs), including one viral [high-risk human papillomavirus (hrHPV), low-risk HPV (lrHPV)], five bacterial [Ureaplasma parvum (UP), Mycoplasma hominis (MH), Ureaplasma urealyticum (UU), Chlamydia trachomatis (CT), and Mycoplasma genitalium (MG)], and one parasitic [Trichomonas vaginalis (TV)] pathogen, were tested by Next Generation Sequencing assay using well-stored baseline samples. Odds ratios (ORs) for incident cervical lesions with different STPs were calculated by Logistic Regression analysis. Within 3-year follow-up, 133 and 72 participants were diagnosed with histopathological cervical intraepithelial neoplasia grade 1 (CIN1) and CIN2+, respectively. The adjusted ORs (aORs) of atypical squamous cells of undetermined significance or worse (ASC-US+) for women with hrHPV, lrHPV, UP, MH, TV, CT, and MG infections were 2.62 (95% CI: 2.19-3.13), 1.94 (95% CI: 1.55-2.43), 1.48 (95% CI: 1.26-1.74), 1.47 (95% CI: 1.25-1.73), 1.65 (95% CI: 1.27-2.15), 1.26 (95% CI: 0.79-2.01) and 2.33 (95% CI: 1.41-3.85), respectively. The aORs of cytological high-grade squamous intraepithelial lesions (HSIL) for women with hrHPV, TV, and MG infections were 13.01 (95% CI: 5.78-29.31), 3.48 (95% CI: 1.38-8.75), and 5.87 (95% CI: 1.58-21.77). The aORs of CIN1 for hrHPV, lrHPV, and MH were 6.88(95% CI: 4.79-9.90), 2.04(95% CI: 1.29-3.14), and 1.47(95% CI: 1.02-2.11). The aOR of CIN2+ for women with hrHPV infection was 17.56 (95% CI: 10.31-29.92), no significance was observed for CIN2+ with non-hrHPV STIs. Specific STP infections were significantly associated with subsequent cervical cytological ASC-US+ (hrHPV, lrHPV, UP, MH, TV, and MG) and HSIL (hrHPV, TV, and MG). Infection with lrHPV and MH could increase the CIN1 risk in future though no obvious CIN2+ risk elevation was observed.

We report a case of a vitreous opacity identified as a white inferiorly located vitreous mass. Vitreous surgical biopsy revealed that it was vitreous metastasis of laryngeal carcinoma. A 56-year-old man on immune-chemotherapy for laryngeal carcinoma presented to our hospital with photopsia in his left eye (OS) for two weeks. Slit-lamp examination revealed 0.5+ cells in the anterior chamber and 0.5+ cells in the vitreous humor OS. The optic nerve papilla was normal in both eyes, although slight macular edema was present OS. A white mass formed by a vitreous opacity precipitated at the inferior of the left fundus. Due to ongoing systemic treatment, the patient was unable to make frequent visits to ophthalmology, and the second visit occurred one month after the initial examination. Fundus angiography revealed retinal vasculitis OS. Two months after the initial visit, tractional retinal detachment with retinal hemorrhage occurred. Therefore, a 25-gauge lens vitrectomy was performed immediately. Histopathological examination of the vitreous obtained intraoperatively revealed atypical squamous cells identified as a vitreous metastasis of laryngeal carcinoma. Vitreous metastasis of laryngeal carcinoma had not been previously reported. On the initial examination, there were few findings other than a white friable mass presenting as a vitreous opacity precipitating at the inferior of the fundus. Vitreous opacity in patients with carcinoma should be considered a potential indicator of metastatic tumors.

Background:Treatment protocol for patients with cervical histologic low-grade squamous intraepithelial lesion (LSIL) such as that preceded by serious cytology and repeated diagnosis for at least 2 years is unclear.Objective:This study investigates the follow-up results of patients with cervical histologic LSIL and aims to provide evidence support for treatment and follow-up strategy.Design:A retrospective observational study design was used.Methods:The retrospective study included 4263 patients with cervical histologic LSIL diagnosed between August 2014 and February 2021. The follow-up period ended in August 2023.Results:During the followed-up of 6–101 months, 3246 (76.1%), 628 (14.7%), and 389 (9.1%) of the 4263 patients had lesion regression, persistence, and progression. Multiple gravidities, high-risk human papillomavirus (HPV) positive, HPV 16 positive, and cytologic examination (⩾atypical squamous cells cannot exclude high grade squamous intraepithelial lesion (ASC-H)) were independent risk factors for histologic LSIL progression. The annual cumulative cervical intraepithelial neoplasia (CIN)3+ rate of patients with histologic LSIL preceded by cytologic ASC-H and gravidity >2 was 6.3% (1-year), 22.4% (2-year), 28.2% (3-year), 28.2% (4-year), and 28.2% (5-year). The cumulative CIN2+ and CIN3+ rates in patients with histologic LSIL under risk factors and repeated diagnosis for at least 2 years were significantly higher than patients preceded by cytologic negative for intraepithelial lesion or malignancy, atypical squamous cells of undetermined significance, and LSIL.Conclusion:Cervical histologic LSIL had a high natural regression rate and a low progression rate. Multiple gravidities, high-risk HPV positivity, HPV 16 positivity, and cytological examination ⩾ASC-H were risk factors for histologic LSIL progression. For patients with histologic LSIL preceded by cytologic ASC-H, stratified management based on the number of gravidities might be an option.