Yeşim Özkaya UÇAR, Okan AYTEKİN, Arife Ebru KUZU, Nazlı Tunca ŞANLIER, Mehmet ÜNSAL, Fatih KILIÇ, Abdurrahman Alp TOKALIOĞLU, Taner TURAN
Journal of Current Hematology & Oncology Research - 2026;4(3):80-85
Aims: To evaluate the clinical and pathological factors associated with invasive cervical cancer in patients referred for colposcopy after abnormal cervical smear screening. Methods: This retrospective cohort study included 5,033 patients aged 18 years and older who underwent colposcopic evaluation between September 2019 and December 2025 at a tertiary gynecologic oncology center after an abnormal cervical smear result. Patients were classified according to the presence or absence of histopathologically documented invasive cervical cancer based on the highest-grade diagnosis available during follow-up. Age, smear category, human papillomavirus (HPV) status, colposcopic biopsy findings, endocervical curettage (ECC) findings, and final pathology results were analyzed. Logistic regression analysis was performed to identify variables independently associated with invasive cervical cancer. Results: Invasive cervical cancer was identified in 32 of 5,033 patients (0.64%). Patients with invasive cancer were significantly older than those without invasive disease (49.8+/-11.0 vs 41.8+/-11.3 years, p=0.00026). High-risk smear findings were more common in the invasive cancer group than in the non-invasive group (46.9% vs 6.1%, p<0.001). Invasive cancer was detected in 4.34% of patients with high-grade squamous intraepithelial lesion or worse (HSIL+) on colposcopic biopsy versus 0.07% of those with non-HSIL biopsy findings (OR 65.99, 95% CI 20.04-217.25, p<0.001). Similarly, invasive cancer was identified in 11.6% of patients with HSIL+ on ECC compared with 0.31% of those with non-HSIL ECC results (OR 42.47, 95% CI 20.76-86.88, p<0.001). In multivariable analysis, older age, high-risk smear findings, HSIL+ on colposcopic biopsy, and HSIL+ on ECC remained significantly associated with invasive cervical cancer. Some invasive cancers were identified only in final pathology specimens, suggesting that preoperative assessment may underestimate invasive disease in a subset of patients. Conclusion: Invasive cervical cancer was uncommon but clinically relevant in patients referred for colposcopy after abnormal cervical smear screening. Older age, high-risk smear findings, HSIL+ on colposcopic biopsy, and HSIL+ on ECC were the variables most strongly associated with invasive disease. An integrated interpretation of cytology, HPV status, biopsy, ECC, and clinical context may improve recognition of patients at increased risk for invasive cervical cancer.
