Cytomorphological Reflections of HPV Positivity in Concurrent HPV Testing and Smear Specimens

Background: Cervical cancer is one of the most common malignancies affecting women worldwide, accounting for approximately 12% of all cancers in women. High-risk human papillomavirus (hrHPV) is the principal etiological agent. Although cytology-based screening remains a cornerstone of early detection, molecular HPV testing enhances sensitivity, particularly for the detection of high-grade lesions and asymptomatic infections. The aim of this study was to investigate cytomorphological features associated with hrHPV positivity in liquid-based papanicolaou smear samples and to evaluate the distribution of hrHPV subtypes according to age groups within a single regional population.Materials and Methods: This retrospective study included 1,500 patients who underwent simultaneous hrHPV DNA testing and liquid-based cytology at the Department of Pathology, Dicle University Faculty of Medicine between 2015 and 2016. hrHPV testing was performed using a fully automated Roche Cobas X4800 system. Cytological evaluations were conducted in accordance with the 2014 Bethesda System. Associations between cytomorphological findings and hrHPV subtypes were analyzed statistically using SPSS v18.0, with p-values < 0.05 considered significant.Results: hrHPV positivity was detected in 141 (9.4%) of the 1,500 cases. Of these, HPV 16 was identified in 26 cases (18%), HPV 18 in 14 cases (10%), and other hrHPV subtypes in 101 cases (72%). No HPV 18 positivity was observed among the ASC-US, LSIL, and HSIL groups. Cytomorphological features, such as perinuclear halo, multinucleation, and parakeratosis, were frequently detected in hrHPV-positive cases. Notably, 138 of 1,418 cases with normal cytology exhibited hrHPV positivity (9.7%), indicating latent or subclinical infection.Conclusions: The combination of molecular hrHPV testing and cytomorphological evaluation enhanced the diagnostic yield of cervical cancer screening. Recognizing the specific cytological features associated with hrHPV can assist in risk stratification and guide clinical management, particularly in cases lacking access to molecular testing. Larger multicenter studies are warranted to validate these associations further.