ABSTRACT Context Cervical cancer remains a major global health concern. Liquid‐based cytology (LBC) is a cornerstone of screening, but its diagnostic accuracy for high‐grade lesions, particularly in specific populations such as Southern China, requires ongoing evaluation. Objective To evaluate the diagnostic accuracy of LBC for high‐grade squamous intraepithelial lesion (HSIL) and squamous cell carcinoma (SCC) in a large Chinese cohort, and to analyse associated human papillomavirus (HPV) genotype patterns and diagnostic pitfalls. Design Retrospective analysis of 518,519 LBC records (2014–2024), focusing on 1758 cases diagnosed as HSIL, HSIL suspected SCC, or SCC. Results The detection rate for HSIL/SCC was 0.34%. Histopathological follow‐up was available for 1315 cases. The concordance rates between cytology and histology were 44.5% for HSIL and 78.5% for SCC. All 52 cases labelled “HSIL suspected SCC” were confirmed as invasive SCC (positive predictive value PPV = 100%). Among discordant cases, 21.9% of cytological HSIL were upgraded to SCC on histology, while 67 cases originally diagnosed as HSIL/SCC were reclassified as other malignancies (e.g., adenosquamous carcinoma). HPV genotypes 16, 58, 52, and 33 were predominant (70.0% in HSIL, 81.0% in SCC). A small proportion (2.3%) of high‐grade lesions were HPV‐negative. Conclusion LBC demonstrates high specificity for SCC and useful predictive value for the “HSIL suspected SCC” category. However, diagnostic challenges remain, including under‐recognition of invasive carcinoma in HSIL cases and misclassification of non‐squamous malignancies. These findings underscore the importance of cytological expertise and the complementary role of HPV testing within screening programs.
Qin et al. (2026) studied this question.