Abstract
Introduction
Since 1 January 2020, diagnostic confirmation of abnormalities detected in the context
of cytology/HPV co-testing in cervical cancer screening under the statutory health
insurance scheme in women aged 35 and over has been performed according to predefined
algorithms. A colposcopy is indicated even in the case of borderline/low-grade cytological
changes and/or HPV persistence. In this article we compare the histology findings
after primary screening examinations in 2020/21 with those from 2018/19, thus also
comparing the results of two different screening approaches.
Patients and Methods
Our analysis included all of the cytology, HPV, and histology results from all primary
screening examinations, as well as the resulting diagnostic confirmation and curative
cases, that could be obtained by 30 June 2023. In 2018/19 these comprised 650600 cytology
and 1804 histology findings, and in 2020/21 there were 491450 cytology and 7156 histology
findings. The absolute numbers of histology findings and the percentage ratios of
these to all cytological diagnoses are presented with comparison factors.
Results
In 2020/21 there were 5.2 times more histology findings in relation to all previous
cytology examinations than in 2018/19, as well as 10.6 times more biopsies, 3.8 times
more conizations, and 1.2 times more hysterectomies. There was a particularly high
increase in diagnostic confirmation of borderline/low-grade or only HPV-positive findings.
With co-testing, 12.7 times more CIN1, 6.4 times more CIN2, and 3.5 times more CIN3
lesions were diagnosed. The proportion of biopsies without dysplasia was 7.6 times
higher than in previous years. Cervical carcinomas were diagnosed 1.8 times more frequently,
and endometrial carcinomas 0.7 times less frequently.
Conclusion
More CIN lesions were found with co-testing, but the increase in histology findings
of low-grade or no dysplasia was far greater than findings of CIN3. Lesions not requiring
treatment accounted for 94.4% of biopsy results in 2020/21. The use of computer-assisted
LBC with progression markers could reduce this.
Keywords
cervical cancer screening - co-testing - HPV - cytology - LBC - histology
