Comparative Diagnostic Yield of HPV DNA Testing, Pap Cytology, And Colposcopy for Cervical Cancer Screening in Pregnant Women: A Cross-Sectional Study

Abstract

Background: Cervical cancer screening during pregnancy provides an opportunity for early detection of cervical abnormalities. HPV DNA testing, Pap cytology, and colposcopy differ in their ability to identify clinically significant cervical lesions.  

Objective: To compare the diagnostic yield of HPV DNA testing, Pap cytology, and colposcopy for detection of clinically significant cervical lesions among pregnant women.

Methods: This cross-sectional comparative study was conducted at tertiary care centers across Pakistan from March 2025 to September 2025, included 300 pregnant women. All participants underwent high-risk HPV DNA testing, Pap cytology, and colposcopic examination.

Results: The mean age of participants was 29.4 ± 5.2 years and mean gestational age was 24.6 ± 8.1 weeks. High-risk HPV DNA was positive in 54 (18.0%) women, while abnormal Pap cytology and colposcopy were found in 32 (10.7%) and 28 (9.3%), respectively. Histopathology identified CIN 2+ in 20 (6.7%) women. HPV DNA testing detected 18 (90.0%) CIN 2+ cases, while Pap cytology detected 14 (70.0%) and colposcopy detected 18 (90.0%). HPV DNA testing showed 90.0% sensitivity, 87.1% specificity, 33.3% positive predictive value, 99.2% negative predictive value, and 87.3% diagnostic accuracy. Pap cytology demonstrated 70.0% sensitivity, 93.6% specificity, 43.8% positive predictive value, 97.8% negative predictive value, and 92.0% accuracy. Conclusion: It is concluded that HPV DNA testing and colposcopy demonstrated the highest sensitivity for detection of CIN 2+, while colposcopy provided the highest specificity and overall diagnostic accuracy. HPV DNA testing may therefore serve as a sensitive screening method, with Pap cytology and colposcopy providing complementary assessment of pregnant women with abnormal screening results.