Süleyman ÖZEN, Eda Güner ÖZEN, Muzaffer SANCI
Çukurova Anestezi ve Cerrahi Bilimler Dergisi - 2026;9(2):390-395
Objective: To evaluate the diagnostic yield and cost-effectiveness of immediate colposcopy versus p16/Ki-67 dual stain (DS) triage in women with non-16/18 high-risk HPV (hrHPV) positivity and normal cervical cytology (NILM) in a tertiary care setting in Türkiye. Materials and Methods: This retrospective cohort study included 454 unvaccinated women with non-16/18 hrHPV positivity and NILM cytology between December 2023 and May 2025. All underwent colposcopy with biopsy when indicated. A decision tree model compared two strategies: (1) immediate colposcopy for all, and (2) DS triage with colposcopy limited to DS-positive cases. DS performance metrics (sensitivity: 70.7%, specificity: 70.8%) were derived from literature. Total costs, colposcopy numbers, CIN2+ detection, and missed cases were calculated. Results: Among 454 patients, 10 (2.2%) were diagnosed with CIN2+ (7 CIN2, 3 CIN3). Immediate colposcopy detected all cases at a total cost of $7,491 with 454 procedures. The DS triage strategy required only 136 colposcopies (70% reduction) but missed 3 CIN2+ lesions and cost $24,944-a 233% increase. Conclusion: While DS triage reduced the number of colposcopies, it missed 30% of CIN2+ lesions and significantly increased costs. In under-screened, high-risk populations such as in Türkiye, immediate colposcopy remains a more effective and economically viable strategy for managing non-16/18 hrHPV-positive, NILM patients.
