{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T11:18:42Z","timestamp":1789730322199,"version":"4.0.1"},"reference-count":48,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: In women who are positive for high-risk human papillomavirus (hrHPV), abnormal cytology necessitates colposcopy and biopsy; however, cytology\u2013histology 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\u2014cannot 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 (&lt;48 years) and postmenopausal (\u226548 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\u2013biopsy 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\u2013histology 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.<\/jats:p>","DOI":"10.3390\/medicina62040631","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T15:10:24Z","timestamp":1774537824000},"page":"631","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cytology\u2013Biopsy Concordance in High-Risk Human Papillomavirus\u2013Positive Women with Abnormal Cytology Findings: Menopause-Stratified Analysis"],"prefix":"10.3390","volume":"62","author":[{"given":"Isik","family":"Sozen","sequence":"first","affiliation":[{"name":"Department of Gynecologic Oncology, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, Ba\u015fak\u015fehir Neighborhood, G-434 Street, No: 2L, Istanbul 34480, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gozde","family":"Sahin","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, Ba\u015fak\u015fehir Neighborhood, G-434 Street, No: 2L, Istanbul 34480, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuksel","family":"Ulu","sequence":"additional","affiliation":[{"name":"Department of Pathology, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7976-6958","authenticated-orcid":false,"given":"Dilara","family":"Yitiz","sequence":"additional","affiliation":[{"name":"Department of Pathology, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0699-0482","authenticated-orcid":false,"given":"Basak Ozge","family":"Kayan","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, Ba\u015fak\u015fehir Neighborhood, G-434 Street, No: 2L, Istanbul 34480, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7337-9977","authenticated-orcid":false,"given":"Ilkbal Temel","family":"Yuksel","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, Ba\u015fak\u015fehir Neighborhood, G-434 Street, No: 2L, Istanbul 34480, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"ref_1","first-page":"322","article-title":"Global burden of cervical cancer: Current estimates, temporal trend and future projections based on the GLOBOCAN 2022","volume":"5","author":"Wu","year":"2025","journal-title":"J. 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