Evaluation of Diagnostic Parameters of Cytodiagnostics as a screening tool conducted in 2005-2020 as part of the National Population-Based Cervical Cancer Screening Program in Poland.

Objectives: We assessed the diagnostic parameters of cytodiagnosis as a screening method used in the National Population-Based Cervical Cancer Screening Program compared to out-program screening.

Material and methods: A retrospective analysis of 800 results obtained during routine screening for the National Population-Based Cervical Cancer Screening Program and out-program samples. Abnormal cytologic interpretations, which were an indication for colposcopy as well as HPV DNA HR test and the final histopathology test, both from in- and out-program patients, were statistically analyzed.

Results: Out of 800 abnormal cytologic results, we obtained 7 - suspicion of squamous cell carcinoma, 105 - HSIL, 152 - ASC-H, 269 - LSIL, 254 - ASCUS, and 13 - AGC. Cervical pathology was confirmed on histopathology in 422 patients: cervical cancer was detected in 21 patients, with the following findings in the remaining women: 103 - CIN 3, 126 - CIN 2, 173 - CIN 1, koilocytosis without CIN - 143, and lesion-free histopathology - 378. Out of 800 abnormal cytologic results, HPV DNA was detected in 539 women, including 387 - HPV DNA HR, 240 - HPV DNA 16, and only 22 - HPV DNA 18.

Conclusions: The prevention program significantly improved the detection parameters of the in-program as compared to out-program cytodiagnostics. The goal of the screening programs should be to identify lesions consistent with ≥ CIN2. Molecular testing, which can identify at least 14 HPV HR genotypes, should be the first-line screening tool. A positive molecular test result should not be an indication for advanced diagnostics. Other than conventional or liquid-based cytology, an ultimate detection test is necessary.