Sarcouncil Journal of Medicine and Surgery

Abstract: Knowledge of the magnitude of this discrepancy and the predictors of such discrepancy is needed to enhance triage algorithms and prevent missed high-grade lesions where purpose was This research compared the precision of cervical cytology with histology, diagnostic measures, and determined independent demographic and clinical predictors of high grade cervical intraepithelial neoplasia (CIN) as well as in our study we collected 90 patients who underwent paired cervical cytology and colposcopy-directed biopsy or conization at a tertiary care unit in the period between January 2024 and December 2025. The variables to be collected were age, BMI, parity, smoking status, menopausal status, and high-risk HPV (hrHPV) status, while Diagnostic performance was measured in terms of sensitivity, specificity, predictive values, and likelihood ratios. Concurrence was assessed using Cohen's and Spearman's Kappa and rank correlation, respectively. Binary logistic regression determined independent predictors of histologically confirmed high-grade lesions. Findings: The mean age was 42.4 + 11.2 years, and 62.2 percent of the participants were positive in the hrHPV test. The sensitivity of cytology was 77.4⁻ , the specificity was 89.8, and the negative predictive value was 88.3. Cytological and histological grade correlation was found to be strong (Spearman's rho 0.001), and weighted Kappa was 0.82, which reflects a high degree of agreement. However, 25.6% of the cases were discordant, primarily because of cytologic underdiagnosis (17.8%), particularly among post-menopausal women. Multivariate logistic regression revealed that the strongest independent predictors of high-grade histology were hrHPV positivity (OR=11.13; 95% CI= 2.93-42.31), abnormal cytology (OR=7.03; 95% CI=3.75-13.16), and age (OR= 1.04/year, p=0.045) lastly Cervical cytology is in agreement with histopathology and has high specificity but moderate sensitivity which leads to clinically significant number of false negative which is more in case of high grade lesion in older women.