Correlation between atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion and cervical lesions: a retrospective analysis of opportunistic and organized cervical screening populations.

Authors

Linhong Liao, Hui Cheng, Hui Su, Xi Wang

Published in

Frontiers in oncology. Volume 16. Pages 1926183. Epub Aug 14, 2026.

Abstract

We compared Liquid-Based Cytologic Test (LCT) results diagnosed as atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H) with high-risk human papillomavirus (hrHPV) infection status and histopathological findings across two cervical screening groups. Additionally, we analyzed the clinical correlation of ASC-H with cervical lesions.
This retrospective analysis included 171,688 cases. LCT specimens were divided into two groups: 31,100 from patients who underwent organized cervical screening with artificial intelligence(AI)-assisted interpretation; and 140,588 from patients who underwent opportunistic screening interpreted manually. Of the 663 cases diagnosed with ASC-H, 387 underwent both HPV testing and subsequent histopathological examination. HPV detection methods included 23-type HPV genotyping, and the Cobas 4800 assay which identifies HPV16/18 plus 12 other hrHPV subtypes.
The overall prevalence of ASC-H was 0.39%. Among 387 paired cases of ASC-H, the total HPV infection rate reached 84.00%, with hrHPV accounting for 97.82% of cases. Women aged <50 years exhibited more single HPV genotype infections and a significantly higher positivity rate for hrHPV than those aged ≥50 years (p<0.05). In 297 ASC-H samples tested by HPV23 genotyping, the most prevalent hrHPV genotypes were HPV16 (28.62%), HPV52 (21.89%), and HPV58 (17.17%). Among 90 ASC-H samples detected with Cobas 4800 (HPV16/18 plus 12 other hrHPV), the infection rates for HPV16, HPV18, and other 12 hrHPV subtypes were 11.11%, 2.22%, and 82.22%, respectively. Histopathological examination confirmed that 137 of the 387 (35.40%) patients with ASC-H had high-grade squamous intraepithelial lesion or worse (HSIL+), with seven HSIL+ lesions testing negative for HPV. Low-grade squamous intraepithelial lesions (LSIL) were identified in 119 cases (30.75%), including 15 that were negative for HPV. There was no significant difference in HSIL+ positivity observed between the two screening groups, whereas the opportunistic screening group showed a significantly higher positivity rate for LSIL compared with the organized cervical screening group (p<0.01).
ASC-H indicates a significant risk of HSIL+, particularly in younger women, regardless of interpretation (AI-assisted or manual). These patients require timely evaluation and suitable treatment, as well as careful follow-up to minimize the risk of missed diagnoses of precancerous lesions and early cervical cancer.

PMID:
42666167
Bibliographic data and abstract were imported from PubMed on 29 Aug 2026.

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