Human Papillomavirus Positivity and Cervical Intraepithelial Lesion in Cervical Biopsy and Endocervical Curettage in Women Younger Than 30 Years

Abstract

Objectives: Assess high-risk human papillomavirus (HPV) prevalence and high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia (HSIL/CIN) grade 2+ detection by cervical biopsy and endocervical curettage (ECC) in women younger than 30years. Methods: We retrospectively analyzed medical records from January 2016 to June 2024 at a tertiary hospital. All women aged 21years and older who underwent HPV and Papanicolaou testing, plus those younger than 30years referred for colposcopy, were included. Data on age, HPV status, cytology, colposcopy-directed biopsy, and ECC findings were extracted. The primary outcome was HSIL/CIN 2+ incidence on pathology. Results: Among 57 381 women, high-risk HPV prevalence was 14.3% overall: 36.8% in those aged 21-24years, 24.0% in those aged 25-29years, and 12.7% in those 30years and older. Of 735 women younger than 30years, 291 were managed by follow-up decision and 444 underwent biopsy/ECC; follow-up decision was more common in women aged 21-24years versus those 25-29 years (49% vs. 35.8%). Among the 444 women who underwent biopsy, HSIL/CIN 2+ and HSIL/CIN 3+ occurred in 37.8% and 14.6%, respectively, with similar HSIL/CIN 3+ rates in those aged 21-24years versus those 25-29years (16.8% vs. 13.9%). In 173 women with benign cytology, 30.1% had HSIL/CIN 2+ on pathology. The number needed to screen for HSIL was approximately 2-3 after co-testing versus approximately 40 with Papanicolaou testing alone. In addition, Papanicolaou test alone demonstrated poor agreement with biopsy/ECC results (low Cohen kappa), confirming its inadequate performance. Two cases of cervical cancers were diagnosed at ages 22 and 29years. Conclusions: Similar high-grade lesion rates in women aged 21-24years and those 25-29years support initiating cervical cancer screening at age 21years. Given the substantial HSIL detection despite benign cytology, co-testing with Papanicolaou and HPV testing is recommended in this age group.