Cytology Triage for HPV-Positive Postmenopausal Women in a Setting of Cervical Cancer Screening.

Background: Globally, cervical cytology continues to serve as the cornerstone of cervical cancer screening programs, but WHO 2021 guidelines advocate HPV DNA testing as the primary screening modality due to its heightened sensitivity. This method necessitates additional triage with cytology or colposcopy to detect precancerous lesions. Hormonal shifts and anatomical alterations in postmenopausal women may impact diagnostic outcomes in either modality.

Aim: To describe the spectrum of cytological lesions in HPV-positive postmenopausal women to detect precancerous lesions as part of cervical cancer screening.

Methods: Conventional cytology smears of high-risk HPV-positive postmenopausal women were reported according to The Bethesda System 2014. Results of follow-up biopsies of the positive smears were recorded, and cyto-histological correlation was performed.

Results: The retrospective study included conventional cytology smears of 124 postmenopausal women positive for high-risk HPV DNA with a mean age of 52 years. Of the 124 cases, 68 were positive for HPV 16 and/or 18, and 56 were positive for other high-risk HPV. On cytology, 78% were negative for intraepithelial lesions. HSIL+ lesions were noted in 12%, and low-grade lesions were noted in 10% of smears with HPV16/18 predominance. Follow-up biopsies of 17 smears revealed SCC in two cases, HSIL+ in 11 cases, LSIL in 2, and 2 were negative/benign lesions. Of the cyto-histological discordant cases, four were upgraded on review.

Conclusion: Cytology is a useful triage tool in detecting preinvasive and early invasive tumors in HPV DNA-positive postmenopausal women.