Swede Score can predict high-grade cervical intraepithelial neoplasia without previous cytology in colposcopies with transformation zone types 1 or 2.

OBJECTIVE

To evaluate the Swede score for the prediction of high-grade cervical lesions in women undergoing colposcopy without cytology results. This simulates the upcoming scenario in Brazil of HPV-based screening for women testing positive for HPV 16/18.

METHODS

This was a partial analysis of an ongoing cross-sectional study that prospectively included 86 women referred for colposcopy due to cytological abnormalities to a public referral center in Rio de Janeiro, Brazil, between September 2023 and June 2025. All women went to colposcopy evaluation. Colposcopy was performed by an examiner blinded to the referral cytology. For this analysis, we included all women with a fully visible squamocolumnar junction (transformation zone types 1 or 2). The gold standard was the histopathological report. In cases where no biopsy or excisional treatment was performed, classification relied on final colposcopic impression and cytology. Diagnostic performance (sensitivity, specificity, predictive values, and likelihood ratios) was calculated using different Swede score cutoffs. Post-test probabilities were calculated assuming a 20% pre-test probability of CIN2+.

RESULTS

Prevalence of CIN2 + was 33.7%. Swede score ≥ 8 predicted CIN2 + with a positive predictive value (PPV) of 100% and a likelihood ratio of 55.17. Post-test probability in a HPV 16/18-positive scenario without cytology in this threshold was estimated at 93%.

CONCLUSION

The Swede score cutoff ≥ 8 in women who tested positive for HPV 16/18 and had fully visible transformation zones can be an accurate method to predict that they have CIN2+. These results could support the decision to proceed with immediate treatment without prior cytology or biopsy. TRIAL REGISTRATION: Not applicable. This study does not report the results of a health care intervention.