The Correlation Between Abnormal Cervical Cytology, Colposcopy, and Histology in the Diagnosis of Cervical Cancer Precursor Lesions

Background: Cervical cancer is the fourth most common cancer among women globally, with the highest burden in low- and middle-income countries. Limited access to screening and treatment contributes to high mortality, despite effective screening methods like HPV testing and cervical cytology. Objectives: To establish the degree of correlation between cervical cytology, colposcopy, and histological features among patients with abnormal cytological smears seen at Nelson Mandela Academic Hospital and MthathaRegional Hospital. Methods: This was an analytical cross-sectional study conducted from June 1, 2024, to June 30, 2025. Two hundred twenty-five participants were enrolled through a convenience sampling method. Demographic and clinical data were collected using a structured questionnaire. Categorical data were expressed as frequencies and proportions, and continuous data were summarized into means ± SD or medians (IQR). X² was used to determine the correlation, and a p-value of <0.05 was significant. Results: The mean age was of the participants was 45.5 years, with 72% being HIV positive. Most cytology results showed high-grade squamous intraepithelial lesions (HSIL). Colposcopy classified 77% of participants as CIN II or III. Both cytology and colposcopy correlated positively with histology p< 0.05. Cytology showed 92% sensitivity and 33% specificity for detecting CIN 2+ lesions, while colposcopy had 87.4% sensitivity and 49% specificity. Micro-invasive cervical cancer was prevalent in 4% of the participants and was associated with age ≥ 50 years and treatment delay of > 4months. Conclusion: Both colposcopy and cytology demonstrated good sensitivity but poor specificity for the diagnosis of CIN 2 or higher dysplastic lesions of the cervix. Early colposcopic evaluation and treatment of women with HSIL can help prevent incident cervical cancer.