Histological outcomes and colposcopic findings in patients with persistent high-risk human papillomavirus infection without major cytological findings

BACKGROUND: High-risk human papillomavirus-based screening demonstrates higher sensitivity but lower specificity than cytology for detecting high-grade squamous intraepithelial lesions. This has increased colposcopy referrals and introduced a new group of patients with persistent high-risk human papillomavirus infections and normal cytology. OBJECTIVE: In this population, we aimed to describe colposcopic findings, evaluate the diagnostic performance of systematic colposcopy using Swedescore, and assess the prevalence of high-grade squamous intraepithelial lesions. STUDY DESIGN: In this retrospective cohort study, we included 493 patients referred to colposcopy through the Finnish national cervical cancer screening program in 2021 following high-risk human papillomavirus infection persistence with negative for intraepithelial lesion or malignancy or atypical squamous cells of undetermined significance triage cytology. We described and compared colposcopic findings and histological outcomes across the cohort, stratified by referral cytology, age, and other subgroups. Statistical analyses included descriptive statistics and hypotheses testing with appropriate parametric and nonparametric tests. RESULTS: Altogether, 17.8% (88/493) of patients had a histologically confirmed high-grade squamous intraepithelial lesion. Prevalence was higher (P