European Journal of Cardiovascular Medicine

Cervical cancer is a major public health concern worldwide, particularly in developing countries where screening coverage remains suboptimal. Persistent infection with oncogenic HPV types is a necessary cause of cervical cancer. The progression from HPV infection to invasive carcinoma is a multistep process involving precursor lesions collectively termed cervical intraepithelial neoplasia (CIN).

Histopathological examination of cervical tissue remains the gold standard for diagnosis, enabling classification of lesions into benign, premalignant, and malignant categories. Concurrently, HPV DNA testing provides etiological confirmation and risk stratification. High-risk HPV types, especially HPV 16 and 18, are implicated in the majority of cervical cancers.

Understanding the correlation between histopathological findings and HPV status is essential for optimizing screening strategies, especially in resource-limited settings. This study was undertaken to evaluate the histopathological spectrum of cervical lesions and correlate these findings with HPV infection.

Study Design and Setting                                                                                              

Cross-sectional observational study conducted in a tertiary care teaching hospital over 24 months.

Study Population

•            Sample size: 200 women

•            Age: ≥21 years

•            Inclusion: Women undergoing cervical screening/biopsy

•            Exclusion: Pregnant women, prior cervical malignancy treatment, inadequate samples

Specimen Collection

Cervical biopsy specimens were obtained via colposcopy-directed biopsy under aseptic precautions.

Histopathological Examination

Tissues were fixed in 10% formalin, processed, and stained with hematoxylin and eosin. Lesions were categorized as:

•            Chronic cervicitis

•            CIN I (LSIL)

•            CIN II & CIN III (HSIL)

•            Invasive carcinoma

HPV DNA Detection

DNA extraction followed by PCR amplification targeting high-risk HPV genotypes (16, 18).

Statistical Analysis

•          Software: SPSS v25

•          Tests: Chi-square test

•         Significance: p < 0.05

A total of 200 women were included in the present study to evaluate the histopathological spectrum of cervical lesions and their correlation with HPV infection. The demographic analysis revealed a mean age of 42.3 ± 11.5 years, indicating that the study population largely comprised middle-aged women. The majority of cases were observed in the 31–50 years age group, which corresponds to the period of increased vulnerability to persistent HPV infection and progression to precancerous lesions. In terms of reproductive history, multiparous women constituted 70% of the study population, suggesting a possible association between higher parity and increased risk of cervical pathology.

Histopathological examination of cervical biopsy specimens demonstrated a wide spectrum of lesions. Chronic cervicitis was the most common finding, accounting for 45% of cases. Among premalignant lesions, cervical intraepithelial neoplasia (CIN) was distributed as follows: CIN I in 25% of cases, CIN II in 15%, and CIN III in 8%. Invasive carcinoma was diagnosed in 7% of cases. This distribution reflects a gradual transition from benign inflammatory conditions to premalignant and malignant lesions, highlighting the importance of early detection and intervention.

HPV DNA testing revealed an overall positivity rate of 18% among the study participants. A progressive increase in HPV positivity was observed with increasing severity of cervical lesions. Among women with chronic cervicitis, only 5% were HPV positive, indicating that most inflammatory lesions may not be associated with persistent HPV infection. In contrast, HPV positivity increased to 12% in CIN I, 30% in CIN II, and 56% in CIN III cases. The highest positivity rate was observed in invasive carcinoma, where 71% of cases tested positive for HPV DNA. This trend clearly demonstrates a strong association between HPV infection and the severity of cervical lesions. Statistical analysis confirmed that this increase in HPV positivity with lesion severity was highly significant (p < 0.001).

Further analysis of HPV genotype distribution revealed that HPV 16 was the most prevalent genotype, detected in 65% of HPV-positive cases. HPV 18 was identified in 25% of cases, while other high-risk genotypes collectively accounted for 10%. The predominance of HPV 16 and 18 is consistent with established evidence identifying these types as the most oncogenic and commonly associated with high-grade lesions and cervical cancer.

Overall, the findings of this study demonstrate a clear and progressive correlation between histopathological severity and HPV infection. The increasing prevalence of HPV, particularly high-risk genotypes, in higher-grade lesions underscores its pivotal role in cervical carcinogenesis. These results emphasize the importance of integrating HPV testing with histopathological evaluation to improve early detection, risk stratification, and management of cervical lesions.

The present study demonstrates a clear association between HPV infection and the severity of cervical lesions. The increasing trend of HPV positivity from benign conditions to invasive carcinoma highlights the etiological role of high-risk HPV types in cervical carcinogenesis.

The predominance of HPV 16 and 18 in high-grade lesions and carcinoma is consistent with global data. Similar studies have reported comparable prevalence patterns and correlations between histopathology and HPV detection.

A substantial proportion of HPV-positive cases were identified in CIN II and CIN III lesions, emphasizing the importance of early detection and intervention at precancerous stages. The relatively lower positivity in cervicitis suggests transient infections or non-HPV-related inflammatory conditions.

The findings reinforce the utility of combining histopathology with molecular diagnostics for improved screening accuracy. In resource-limited settings, targeted HPV testing in high-risk groups can significantly enhance early diagnosis.

This study highlights a significant correlation between histopathological grading of cervical lesions and HPV infection. HPV positivity increases progressively with lesion severity, with HPV 16 being the most prevalent genotype. Integration of HPV testing with routine histopathological evaluation can improve early detection, guide management, and reduce cervical cancer burden.

LIMITATIONS

• Single-center study
• Limited sample size
• Restricted HPV genotyping
• Lack of longitudinal follow-up.

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